Ambiguous Loss and Unresolved Grief

Rarely in human relationships are people totally absent or present. When loved ones disappear without finality of death, symptoms of unresolved grief appear. The cause, however, emanates from an external context of ambiguity that lies beyond the symptom bearer's control. Since the 1970s, this phenomenon has been called ambiguous loss. Unlike the clearer loss of death, ambiguous loss has no official validation of loss and thus fewer supports and rituals to help people begin grieving and coping. Without evidence of death, the incongruence between absence and presence is so distressing it can traumatize and immobilize individuals and families for years.

Types of Ambiguous Loss

There are many kinds of ambiguous losses, but these tend to fall within two types, one physical and the other psychological. In both types, however, a loved one's absence or presence, or status as dead or alive, remains unclear. Both types can occur at the same time.

Type 1 ambiguous loss occurs when a family member is gone but not gone for certain. Such people are physically absent but kept psychologically present because they could return. Catastrophic examples are people who have disappeared, been kidnapped, or are lost without a trace at sea or in wartime. More common examples of the physically missing are those due to divorce, adoption, incarceration, military deployment, and immigration. This first type of ambiguous loss is also called “leaving without good-bye.” People are deprived of physical access to someone they care about, so they suffer a double loss: the loss of that missing person's physical presence plus the loss of volition in being able to say farewell. For example, in the case of people gone missing in wartime, children kidnapped, or infants given up for adoption, the physical transformation that marks death is a privilege denied. Without official verification or a body to bury, such families may never be assured of death, so they must live with the pain of no closure.

Type 2 ambiguous loss occurs when a loved one is physically present but psychologically absent. That is, they are here, but not here. The absence of such a loved one may be due to addiction, obsessions, or extreme preoccupation with work. Catastrophic examples result from dementias, brain injury, autism, and chronic mental illnesses. More common examples result from depression and, pertinent to this discussion, the melancholia of unresolved grief. This type of ambiguous loss is also called a “good-bye without leaving.”

Brief History of Research and Theory Development

Grounded in stress theory, which focuses on the management of relationship stressors (in this case, ambiguity), the research on ambiguous loss began in the 1970s with families of soldiers missing in action in Vietnam and Southeast Asia. Since then, research has continued with families where there is dementia, military deployment, autism, traumatic brain injury, and family estrangement due to sexual orientation. Ambiguous loss theory has been applied to guide family and community-based interventions to cope with losses due to Alzheimer's disease, the missing after the terrorist acts of September 11, 2001, the kidnapped in Kosovo, the swept away in South Asia after the tsunami, and the displaced after Hurricane Katrina, among others. Whether loved ones are lost in body or mind, their families are likely to experience frozen grief—a sorrow that never ends because the mystery never ends. The therapeutic goal therefore is not closure but rather an increased tolerance for ambiguity. This is not an easy task in a culture that values mastery and certainty.

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