Ambiguous loss is a loss that occurs without a significant likelihood of reaching emotional closure or a clear understanding. [1] [2] This kind of loss leaves a person searching for answers, and thus complicates and delays the process of grieving, and often results in unresolved grief. Some examples are infertility, termination of pregnancy, disappearance of a family member, [3] death of an ex-spouse, and a family member being physically alive but in a state of cognitive decline due to Alzheimer's disease or dementia. [4] [5] An ambiguous loss can be categorized into two types of loss: physical or psychological. [6] Physical loss and psychological loss differ in terms of what is being grieved for, the loss of the physical body, or the psychological mind. Experiencing an ambiguous loss can lead to personal questions, such as, "Am I still married to my missing spouse?," or "Am I still a child to a parent who no longer remembers me?". [7] Since the grief process in an ambiguous loss is halted, it is harder to cope or move on to acceptance from the type of loss experienced. There are various types of grief that can occur due to the type of ambiguity experienced and corresponding therapy techniques to address the certain types of grief. The overall goal of therapy to cope with ambiguous loss is to overcome the trauma associated with it and restore resilience. [8]
The term "ambiguous loss" was first used in the late 1970s by Pauline Boss, a researcher who studied families of soldiers who went missing in action. [9] From 1973 to 1977, Boss had used the term "boundary ambiguity", but she later replaced that with "ambiguous loss". [9]
An ambiguous loss can be physical or psychological in nature.
A physical ambiguous loss means that the body of a loved one is no longer around, such as a missing person or unrecovered body from war, but is still remembered psychologically due to the chance of coming back, for example in missing person cases. [6] A physical ambiguous loss can occur across generations, such as the families of victims of the holocaust, and can cause as traumatic distress as Posttraumatic stress disorder. [10]
The second type of ambiguous loss is where a person is still physically there, but is psychologically absent. [6] This happens in cases where the brain is affected, therefore affecting the behavior or well-being of the individual. Psychological ambiguous loss does not just occur to family and friends of the person affected. Psychological loss can happen personally in terms of one losing sense of who they are. This can stem from having a traumatic brain injury and not knowing who they are, causing a lost feeling and uncertain identity issues. [11]
The grieving process for an ambiguous loss differs from regular mourning in that one is unable to gain closure due to unresolved grief. [12] In cases of a psychological ambiguous loss, the grieving process can be especially difficult because of the inability to accept or admit that there is a problem and confront the situation in the first place to deal with the issue. [13] One key factor in getting over an ambiguous loss is resilience. In the normal grieving process, people obtain closure after dealing with a loss. In an ambiguous loss, closure does not exist, and should not be sought after in this case. [6]
Resilience and hope are important in the case of an ambiguous loss because paired together, they are able to allow the individual to come to terms with the loss and continue moving forward in life. [12] [13] One way to tell that someone is resilient in a case with ambiguous loss is that they actively seek out help when they know it is needed. [14] Uncontrollable factors such as culture, age, socioeconomic status, and genetics are all factors that contribute to resilience. [15] Trauma and ambiguous loss often co-exist together and if the trauma is not dealt with it can trigger unresolved emotions. [8] Therapy will address a case of ambiguous loss by restoring resilience, and reconnecting with the loss and the relationship with whom the loss is associated. [8]
The difference between regular grief and grief from an ambiguous loss is the type of loss creates the type of grief experienced. [9] [16] Grief in ambiguous loss can be both beneficial and difficult. Since the grief in an ambiguous loss differs than the linear stages of grief there is no pressure to move on or achieve closure, and this allows for people to remember the lost loved one and move on with relationships and life. [9] There are three specific types of grief that can develop from the type of ambiguous loss.
Anticipatory grief occurs before bereavement, mourning after death occurs, and upon realizing that death may be imminent for a loved one, anticipatory grief sets in. [17] [9] This type of grief is common among families who have a loved one living with Alzheimer's disease. The grief becomes anticipatory due to the knowledge that the loved one's mental state will only become worse, so the grieving process can start very early. [9]
The second type of grief that can develop from an ambiguous loss is disenfranchised grief. [9] [18] It is also known as unrecognized grief because it often occurs in the loss of a beloved pet and the grief is not taken seriously. [9] [18] Ecological Grief or Climate Grief has also been identified as a form of disenfranchised grief. [19] [20]
Frozen grief is the third type of grief, it is a result of the ambiguity of death because of the physical or psychological disappearance and therefore one's grief is frozen since they do not get a chance to let grief run a normal course. [9] [21]
Grief is the response to loss, particularly to the loss of someone or some living thing that has died, to which a bond or affection was formed. Although conventionally focused on the emotional response to loss, grief also has physical, cognitive, behavioral, social, cultural, spiritual and philosophical dimensions. While the terms are often used interchangeably, bereavement refers to the state of loss, while grief is the reaction to that loss.
Psychological trauma is an emotional response caused by severe distressing events that are outside the normal range of human experiences, such as violence, rape, or terrorist attack. The event must be understood by the affected person as directly threatening the affected person or their loved ones with death, severe bodily injury, or sexual violence; indirect exposure, such as from watching television news, may be extremely distressing and can produce an involuntary and possibly overwhelming physiological stress response, but does not produce trauma per se.
Psychological resilience is the ability to cope mentally and emotionally with a crisis, or to return to pre-crisis status quickly.
Disenfranchised grief is a term coined by Dr. Kenneth J. Doka in 1989. This concept describes the fact that some forms of grief are not acknowledged on a personal or societal level in modern day Euro-centric culture. For example, those around you may not view your loss as a significant loss, and they may think you don’t have the right to grieve. They might not like how you may or may not be expressing your grief, and thus they may feel uncomfortable, or judgmental. This is not a conscious way of thinking for most individuals, as it is deeply engrained in our psyche. This can be extremely isolating, and push you to question the depth of your grief and this loss you’ve experienced. This concept is viewed as a ”type of grief”, but it more so can be viewed as a "side effect" of grief. This also is not only applicable to grief in the case of death, but also the many other forms of grief. There are few support systems, rituals, traditions, or institutions such as bereavement leave available to those experiencing grief and loss.
Anticipatory grief refers to a feeling of grief occurring before an impending loss. Typically, the impending loss is the death of someone close due to illness. This can be experienced by dying individuals themselves and can also be felt due to non-death-related losses like a scheduled mastectomy, pending divorce, company downsizing, or war.
Childhood trauma is often described as serious adverse childhood experiences (ACEs). Children may go through a range of experiences that classify as psychological trauma; these might include neglect, abandonment, sexual abuse, emotional abuse, and physical abuse, witnessing abuse of a sibling or parent, or having a mentally ill parent. These events have profound psychological, physiological, and sociological impacts and can have negative, lasting effects on health and well-being such as unsocial behaviors, attention deficit hyperactivity disorder (ADHD), and sleep disturbances. Similarly, children whose mothers have experienced traumatic or stressful events during pregnancy have an increased risk of mental health disorders and other neurodevelopmental disorders.
Grief counseling is a form of psychotherapy that aims to help people cope with the physical, emotional, social, spiritual, and cognitive responses to loss. These experiences are commonly thought to be brought on by a loved person's death, but may more broadly be understood as shaped by any significant life-altering loss.
Ghost sickness is a cultural belief among some traditional indigenous peoples in North America, notably the Navajo, and some Muscogee and Plains cultures, as well as among Polynesian peoples. People who are preoccupied and/or consumed by the deceased are believed to suffer from ghost sickness. Reported symptoms can include general weakness, loss of appetite, suffocation feelings, recurring nightmares, and a pervasive feeling of terror. The sickness is attributed to ghosts or, occasionally, to witches or witchcraft.
In psychology, posttraumatic growth (PTG) is positive psychological change experienced as a result of struggling with highly challenging, highly stressful life circumstances. These circumstances represent significant challenges to the adaptive resources of the individual, and pose significant challenges to the individual's way of understanding the world and their place in it. Posttraumatic growth involves "life-changing" psychological shifts in thinking and relating to the world and the self, that contribute to a personal process of change, that is deeply meaningful.
George A. Bonanno is a professor of clinical psychology at Teachers College, Columbia University, U.S. He is responsible for introducing the controversial idea of resilience to the study of loss and trauma. He is known as a pioneering researcher in the field of bereavement and trauma. The New York Times on February 15, 2011, stated that the current science of bereavement has been "driven primarily" by Bonanno. Scientific American summarized a main finding of his work, "The ability to rebound remains the norm throughout adult life." In 2019, Bonanno was honored with the James McKeen Cattell award from the Association of Psychological Science "for a lifetime of intellectual achievements in applied psychological research and their impact on a critical problem in society at large" and by the International Positive Psychology Association for "distinguished lifetime contributions to positive psychology".
The terms delayed grief and unresolved grief are variations of grieving after a loss. The meaning of unresolved grief is any aspect of grieving that has yet to be resolved.
Family estrangement is the loss of a previously existing relationship between family members, through physical and/or emotional distancing, often to the extent that there is negligible or no communication between the individuals involved for a prolonged period.
The effects of climate change on mental health and wellbeing are documented. This is especially the case for vulnerable populations and those with pre-existing serious mental illness. There are three broad pathways by which these effects can take place: directly, indirectly or via awareness. The direct pathway includes stress-related conditions caused by exposure to extreme weather events. These include post-traumatic stress disorder (PTSD). Scientific studies have linked mental health to several climate-related exposures. These include heat, humidity, rainfall, drought, wildfires and floods. The indirect pathway can be disruption to economic and social activities. An example is when an area of farmland is less able to produce food. The third pathway can be of mere awareness of the climate change threat, even by individuals who are not otherwise affected by it.
The dual process model of coping is a model for coping with grief developed by Margaret Stroebe and Henk Schut. They studied grief in their work "The Dual Process Model of Coping with Bereavement: A Decade On". It examines this model of coping and how it could be of benefit compared to others.
Early childhood trauma refers to various types of adversity and traumatic events experienced during the early years of a person's life. This is deemed the most critical developmental period in human life by psychologists. A critical period refers to a sensitive time during the early years of childhood in which children may be more vulnerable to be affected by environmental stimulation. These traumatic events can include serious sickness, natural disasters, family violence, sudden separation from a family member, being the victim of abuse, or suffering the loss of a loved one. Traumatic experiences in early childhood can result in severe consequences throughout adulthood, for instance developing post-traumatic stress disorder, depression, or anxiety. Negative childhood experiences can have a tremendous impact on future violence victimization and perpetration, and lifelong health and opportunity. However, not all children who are exposed to negative stimuli in early childhood will be affected severely in later life; some children come out unscathed after being faced with traumatic events, which is known as resilience. Many factors can account for the invulnerability displayed by certain children in response to adverse social conditions: gender, vulnerability, social support systems, and innate character traits. Much of the research in this area has referred to the Adverse Childhood Experiences Study (ACE) study. The ACE study found several protective factors against developing mental health disorders, including mother-child relations, parental health, and community support. However, having adverse childhood experiences creates long-lasting impacts on psychosocial functioning, such as a heightened awareness of environmental threats, feelings of loneliness, and cognitive deficits. Individuals with ACEs are more prone to developing severe symptoms than individuals in the same diagnostic category.
Dov Shmotkin is Professor Emeritus in the School of Psychological Sciences and Head of the Herczeg Institute on Aging at Tel Aviv University.
Miscarriage and grief are both an event and subsequent process of grieving that develops in response to a miscarriage. Almost all those experiencing a miscarriage experience grief. This event is often considered to be identical to the death of a child and has been described as traumatic. But the vast majority of those who have suffered both have said they are nothing alike. They describe losing a child as being in a category of its own when it comes to grief. "Devastation" is another descriptor of miscarriage. Grief is a profound, intensely personal sadness stemming from irreplaceable loss, often associated with sorrow, heartache, anguish, and heartbreak. Sadness is an emotion along with grief, on the other hand, is a response to the loss of the bond or affection was formed and is a process rather than one single emotional response. Grief is not equivalent to depression. Grief also has physical, cognitive, behavioral, social, cultural, and philosophical dimensions. Bereavement and mourning refer to the ongoing state of loss, and grief is the reaction to that loss. Emotional responses may be bitterness, anxiety, anger, surprise, fear, and disgust and blaming others; these responses may persist for months. Self-esteem can be diminished as another response to miscarriage. Not only does miscarriage tend to be a traumatic event, women describe their treatment afterwards to be worse than the miscarriage itself.
Mental disorders can be a consequence of miscarriage or early pregnancy loss. Even though women can develop long-term psychiatric symptoms after a miscarriage, acknowledging the potential of mental illness is not usually considered. A mental illness can develop in women who have experienced one or more miscarriages after the event or even years later. Some data suggest that men and women can be affected up to 15 years after the loss. Though recognized as a public health problem, studies investigating the mental health status of women following miscarriage are still lacking. Posttraumatic stress disorder (PTSD) can develop in women who have experienced a miscarriage. Risks for developing PTSD after miscarriage include emotional pain, expressions of emotion, and low levels of social support. Even if relatively low levels of stress occur after the miscarriage, symptoms of PTSD including flashbacks, intrusive thoughts, dissociation and hyperarousal can later develop. Clinical depression also is associated with miscarriage. Past responses by clinicians have been to prescribe sedatives.
Ecological grief, or in particular climate grief, refers to the sense of loss that arises from experiencing or learning about environmental destruction or climate change. Environmental grief can be defined as "the grief reaction stemming from the environmental loss of ecosystems by natural and man-made events." Another definition is "the grief felt in relation to experienced or anticipated ecological losses, including the loss of species, ecosystems, and meaningful landscapes due to acute or chronic environmental change." For example, scientists witnessing the decline of Australia's Great Barrier Reef report experiences of anxiety, hopelessness, and despair.
The psychological impacts of climate change may refer to the effects that climate change can have on individuals’ mental and emotional well-being. They may also refer to more generalised effects on groups and their behaviours, such as the urge to migrate from affected areas of the globe to areas perceived as less affected. These impacts can manifest in various ways and affect people of all ages and backgrounds. Some of the key psychological impacts of climate change include: emotional states such as eco-anxiety, ecological grief, eco-anger or solastalgia. While troublesome, such emotions may not appear immediately harmful and can lead to a rational response to the degradation of the natural world motivating adaptive action. However, there can be other effects on health, such as post-traumatic stress disorder (PTSD), for instance, as a result of witnessing or seeing reports of massive wildfires, which may be more dangerous.
