Both Present And Absent: Understanding Ambiguous Loss
Can There Be Loss Without Death?
Our lives are filled with losses, both major and minor. Losses can occur without death; those we value may gradually fade from our lives. A loved one may be physically present, yet we may feel like a stranger when looking into their eyes. Alternatively, there may be loved ones whose survival we cannot be certain of, yet whom we strive to keep alive in our hearts.
These experiences are also forms of loss.
The absence of a physical death leaves us in an ambiguous space between presence and absence. It is as if the loved one is simultaneously present and absent. When the loss we experience is ambiguous, the grieving process becomes complicated; this is a normal reaction to an abnormal situation. The problem lies not within the individual but within the context of uncertainty (Boss & Carnes, 2012). In losses that defy comprehension—such as suicide, homicide, or the loss of an unborn child—uncertainty persists even when physical death is present.
The Theory Of Ambiguous Loss
The concept of ambiguous loss was first introduced by Pauline Boss. Defined as a state of in-betweenness where one fluctuates between the presence and absence of a loved one, ambiguous loss can be either physical or psychological. In both cases, there is a discrepancy between absence and presence.
1. Psychological Presence With Physical Absence (Leaving Without Saying Goodbye)
The person is not physically present, and it is unclear whether they are alive. However, we seek to maintain their psychological presence. This occurs in devastating situations such as missing persons during war, terrorism, genocide, or natural disasters, as well as kidnappings and unrecovered bodies. It is also observed in more common instances like divorce, adoption, or loss of contact.
2. Physical Presence With Psychological Absence (Saying Goodbye Before Leaving)
Even if the loved one is right beside us, the reality of the bond we share may feel ambiguous. The person is alive but is lost in a cognitive and emotional sense (Demir, 2020). This may include Alzheimer’s disease, dementia, traumatic brain injury, AIDS, autism, schizophrenia, clinical depression, addiction, or a separation occurring without a clear farewell. Individuals experiencing psychologically ambiguous loss, in particular, may not even realize they are undergoing a loss (Boss, 2010).
In a study conducted by Çelik (2013) with university students, paternal characteristics such as a lack of active role in childcare, indifference, superficial or distant communication, and emotional disconnection were perceived by young adults as ambiguous loss (Özgeldi & Gölge, 2018).
According to Boss, these two types of ambiguous loss can often be seen together (Özgeldi & Gölge, 2018), and multiple types of ambiguous loss can be experienced within the same family (Çelik Ateş, 2024).
The Effects Of Ambiguous Loss
When the loss of a loved one is ambiguous, the intense uncertainty creates stress, can leave trauma-like effects, and may lead to a state of immobilization. Over time, expectations toward the person being grieved begin to diminish. As the person’s cognitive or psychological presence fades, family members gradually witness the disappearance of their loved one.
Since a clear farewell and closure cannot be achieved, the state of loss continues in a perpetual cycle. Recovery after loss becomes nearly impossible because the ambiguity constantly makes itself felt. Feeling powerless to break this cycle, individuals may experience helplessness and chronic sorrow (Kahraman, 2021).
Living With Boundary Ambiguity
Family members attempting to cope with the ambiguity of loss may experience conflict and contradictory emotions. They may feel anger toward attempts to preserve the person as they were or toward the exclusion of the lost person’s roles, while simultaneously feeling guilt and shame for harboring such anger (Boss, 2010).
For families struggling with these contradictory emotions, the ability to find logic or meaning in the uncertainty is impaired. Following the ambiguous loss of a family member, the distinction between who is “in” and who is “out” of the family system becomes blurred. As boundaries and roles within the family become obscured, boundary ambiguity is experienced.
Roles and identities become confused, duties go unfulfilled, decisions are suspended, and the family enters a state of stagnation. For instance, uncertainty may arise regarding who now holds the maternal role (Kahraman, 2021). Over time, this hinders the family’s ability to cope with stress, and the grieving process becomes frozen (Özgeldi & Gölge, 2018).
Individuals experiencing ambiguous loss feel trapped between grieving and moving on (Boss, 2010). This ambiguity can erode the resilience of both the individual and the family. Furthermore, there are no social or religious rituals in society to cope with such a loss. However, even if we cannot change the uncertainty of the loss itself, is it possible to increase our resilience and focus on our strengths?
What Can We Do To Increase Our Resilience?
As Aaron Antonovsky (1987) suggested, it is primarily important to know that the situation is manageable (Boss & Carnes, 2012). We can eventually learn to live with uncertainty. The path to finding peace within this vicious cycle begins with accepting that the loved one’s psychological or physical presence is no longer there (Kahraman, 2021).
According to Boss, the point of focus should not be achieving a farewell or closure. In the case of ambiguous loss, the expectation of closure is an unhealthy one that could last a lifetime. Because uncertainty continues in a cycle and the grieving process remains frozen, traditional grief therapies may not be effective (Boss, 2023).
The primary goal is to increase our tolerance for uncertainty and unanswered questions. Increasing this tolerance frees us from the compulsion to “close the door” on the loss. This freedom is the essence of resilience (Boss & Carnes, 2012). Within the ambiguity and contradictions of a loss we cannot fully comprehend, our focus should be on constructing meaning around the uncertainty itself.
Developing Dialectical Thinking Skills
To gain resilience in the face of both presence and absence, we must first accept the coexistence of opposites. Developing internal resources and building personal strengths can support this process. Examples of dialectical thinking include:
“Even though they are gone, they are still with me.” – Psychological ambiguous loss.
“They have migrated elsewhere; therefore, I view them as if they have passed away.” – Physical ambiguous loss (Boss, 2023).
Creating Our Psychological Family
According to Boss, family structure does not have to be solely biological. Beyond the physical presence of our family, we desire them to be psychologically supportive as well. The psychological family is one we construct in our hearts and minds; it is the mental representation of a family. It is not an alternative to the biological family but an extension of it.
A person in our psychological family may or may not be physically alive. In moments of stress, we strive to reach out to the loved ones in our hearts and minds to gain support and endure difficulties (Özgeldi & Gölge, 2018). By creating our own psychological family, we strengthen our external resources to cope with the ambiguity of loss.
It should be remembered that humans can carry uncertainty and, by developing resilience, can lead a good and peaceful life despite the ambiguity of loss (Boss & Carnes, 2012).
References
Boss, P. (2023). Ambiguous Loss – Belirsiz Kayıp. Earthquake Psychosocial Solidarity Network (DEPSDA), 10–11 July 2023, Istanbul. https://www.youtube.com/watch?v=G3yvIrZ0jD0&t=1s
Boss, P. (2002). Ambiguous Loss: Working with Families of the Missing. Family Process, 41, 14–17.
Boss, P. (2010). The Trauma and Complicated Grief of Ambiguous Loss. Pastoral Psychology, 59(2), 137–145.
Boss, P., & Carnes, D. (2012). The Myth of Closure. Family Process, 51(4), 456–469. https://doi.org/10.1111/famp.12005
Çelik Ateş, E. G. (2024). Boşanmış Ailelerde Muğlak Kayıplar [Ambiguous Losses in Divorced Families]. Doctoral Thesis, Ankara University, Institute of Educational Sciences, Ankara.
Demir, R. (2020). Belirsiz Kaybın Kuşaklararası Aktarımı: Cumartesi Anneleri/İnsanları Örneği. Master’s Thesis, Istanbul Bilgi University, Istanbul.
Kahraman, M. E. (2021). Belirsiz Kayıp Üzerine Bir Çalışma. Master’s Thesis, Maltepe University, Graduate Education Institute, Istanbul.
Küçükkaragöz, H., & Meylani, R. (2024). Ambiguous Losses and Their Traumatic Effects: A Qualitative Synthesis of the Research Literature. Western Anatolia Journal of Educational Sciences, 15(2), 721–755.
Özgeldi, E. B., & Gölge, Z. B. (2018). Belirsiz Kayıp: Belirsizlikle Yaşamayı Öğrenmek. Turkish Psychology Writings, 21(42), 108–120. https://doi.org/10.31828/tpy1301996120180618m000001