ambiguous loss

from ambiguous loss by pauline boss

"the outcomes of ptsd are also similar, though not identical, to outcomes of long-term ambiguous loss. both can result in depression, anxiety, psychic numbing, distressing dreams, and guilt. but ambiguous loss is unique in that the trauma goes on and on in what families describe as a rollercoaster ride, during which they alternate between hope and hopelessness. a loved one is missing, then sighted, then lost again. or a family member is dying, then goes into remission, then the illness returns again in full force. hopes are raised and dashed so many times that psychically people no longer react."

"learning to live with the ambiguity of divorce and remarriage requires a whole new set of skills. the first is to revise our perception of who our family is and who it is not. . . all this requires a second skill, the ability to let go of needing an absolute and precise definition of family. . . rather than weakening the family, such elasticity in family composition enhances resilience and flexibility. . . in a sense one has to abandon the concept of monogamy in order to make divorce and remarriage work because a first marriage does not simply stop when a second one starts. it is forever a part of the fabric of one's life."

"ambivalence can result from the ambiguity of not knowing who is included in the structure that is supposed to be one's family. conflicting impulses that may exist in the psyche are often a consequence of this uncertainty.

ambivalence is often intensified by deficiencies outside the family -- officials cannot find a missing person or medical experts cannot clearly diagnose or cure a devastating illness. because of the ambiguity, loved ones can't make sense out of their situation and emotionally are pulled in opposing directions -- love and hate for the same person; acceptance and rejection of their caregiving role; affirmation and denial of their loss. often people feel they must withhold their emotions and control their aggressive feelings because social norms dictate that becoming upset is inappropriate and will only bring further harm to the missing person, demented elder, or comatose child. this is the bind, especially for women, who are most often caught in caregiving or waiting roles.

mixed emotions are compounded when a separation involves the potential of irretrievable loss. when there is a chance that we will never see a loved one again, we protect ourselves from the prospect of losing that person by becoming ambivalent -- holding our spouse at arm's length, picking a fight with a parent, or shutting a sibling out even when he or she is still physically present. anticipating a loss, we both cling to our loved ones and push them away. we resist their leaving and at the same time want to be finished with the goodbye."

"if we are to turn the corner and cope with uncertain losses, we must first temper our hunger for mastery. this is the paradox. to regain a sense of mastery when there is ambiguity about a loved one's absence or presence, we must give up trying to find the perfect solution. we must redefine our relationship to the missing person. most important, we must realize that the confusion we are experiencing is attributable to the ambiguity rather than to something we did -- or neglected to do."

"for people who are accustomed to having some control over their lives, insight appears to help; such people want to understand 'why,' to penetrate the deeper meaning of an experience before they risk doing something different. but for others, insight is gained experientially, not cognitively. for them, the family therapist carl whitaker was right when he said, 'you only know what something is after you've gone past it.' people have to experience a phenomenon before they can understand it. what is clear to me is that we as clinicians must be more sensitive to individual differences in ways of understanding a situation if we are to avoid creating the very resistance we sometimes attribute to the people we are trying to help."