In the world of loss and grief, there is a unique kind of loss that complicates, confuses, and blocks resolution. It’s called “ambiguous loss” (Boss, 1999). This previously unnamed kind of loss lies at the root of much global uncertainty, trauma, and human conflict. While people, even across cultures, know what to do when a verified death occurs, less attention is paid to ambiguous losses, the losses we can’t clarify or resolve. Unlike with death, there is no certainty about the loss, no official notice in a newspaper, and no rituals of comfort for family and friends left behind. Yet, the trauma and anxiety of ambiguous loss can devastate young and old.

As I wrote in my 2022 book, The Myth of Closure: Ambiguous Loss in a Time of Pandemic and Change, the COVID-19 pandemic brought with it the ambiguous losses of being unable to be with loved ones who were dying, not being able to hug or touch loved ones, having no rituals of grief or joy in community with others. Young people lost the usual rituals of early life, graduations, proms, weddings. For all ages, there was the loss of daily routines, loss of freedom, loss of traveling. But perhaps the most stressful and anxiety-producing was the loss of trust in the world as a safe and predictable place.

How do we respond? Thus far, I read and hear that we have a mental health crisis in this country. I am not so sure. Indeed, we have a crisis of anxiety and sadness, but these are normal reactions to abnormal situations — an abnormal context. Early on in the pandemic, we all felt the loss of control due to a new and deadly virus. Today, there is more control due to vaccines, but now there are mass shootings, more powerful natural disasters, and the threat of nuclear Armageddon as a nuclear plant in Ukraine is now the target of war. If we are anxious and sad because such ambiguity exists about the world as a safe and predictable place, do all people with anxiety and sadness have a mental illness? Or do we need systemic change to lessen the stress and trauma in our human environment? Might it be helpful to name our unresolved ambiguous losses so that we can see the problem? Knowing what our global threats are, we are more likely to act and change our ways.

For over four decades, my work with ambiguous loss (a term I coined in the late-1970s) focused on individuals and families. Back then, I studied wives of soldiers missing in action in Vietnam and Southeast Asia. This was physical ambiguous loss. A decade later, I studied the wives of aging veterans who had Alzheimer’s disease, a psychological ambiguous loss. The result: a heretofore painful and unacknowledged loss now had a name.

While my original focus on ambiguous loss, and that of other researchers and clinicians, was dyadic or familial, the COVID-19 pandemic expanded my view to propose that ambiguous losses can also occur globally to the larger human family. I name two — the possibility of nuclear disasters and climate change.

Global Ambiguous Loss from Nuclear Disasters

Since March 2022, Russian soldiers have occupied the Zaporizhzhia nuclear power plant in Ukraine, as a target of war, this site is now threatening nuclear disaster to all of Europe, as well as the world. In addition to massive deaths, there would be loss of homes and farmlands — both examples of physical ambiguous losses — plus loss of status and identity as farmers, landowners — both psychological ambiguous losses. Globally, an example of psychological ambiguous loss is that people are losing their sense of trust of the world as a safe place. If not intentional for war, nuclear catastrophes can still occur. For example, after the earthquake and tsunami in Japan on March 11, 2011, the dislocated farmers along the coast said their loss was not only loved ones washed away and missing, but also the loss of their ancestral farmlands, now poisoned by the failure of the Fukushima Daiichi nuclear plant. While the poisoning of their lands was not their fault, their guilt was immense and traumatizing (Boss and Ishii, 2015).

Currently, I am working with Ukrainian therapists whose fellow citizens suffer deeply, not only with death, but with an epidemic of ambiguous losses. Most families are now physically separated: fathers staying to fight, mothers fleeing to safety with their children; many not knowing where the others are — or if they are alive or dead. Others have simply disappeared, being forced elsewhere. Ambiguous loss, I am told, has become the norm.

Such widespread doubt and confusion about the whereabouts of loved ones understandably leads to widespread anxiety, ambivalence, and frozen grief (Boss, 1999, 2004, 2006, 2016, 2022). Indeed, cultural values influence people’s tolerance for ambiguity, but most of us in Western culture prefer certainty.  

Global Ambiguous Loss from Climate Change

As the earth warms, glaciers melt, oceans rise, and yet, rivers go dry. With the paradox of both too much and too little water, confusion follows. People wait. Deaths increase from more devastating floods and droughts while many of us, especially in developed countries, do not see clearly the extent of what is already being lost. As a result, many do not act — or care.

 If we give a name to the losses from climate change — not just deaths, but ambiguous losses — might more leaders and citizens see the urgency for action? Might we become more aware of what can't always be quantifiable — of what is still doubted and thus ambiguous.

Addressing Ambiguous Loss

The global family is in trouble now as there is dire need to understand the reality of losses that are not yet noticed or acknowledged, and thus not dealt with. The theory of ambiguous loss provides a useful lens for understanding the magnitude of global losses. Physically, the glaciers, forests, and fertile soils are “going missing;” the beautiful beaches where we swam are vanishing. Psychologically, we are losing our trust in the world as a safe and predictable place.

The goal for easing the stress and anxiety of ambiguous loss is to build enough resilience for people to live with the losses that likely will never be resolved. Because there is no finality, grief therapy does not work with ambiguous loss. Instead, we recommend holding two opposing ideas in one’s mind at the same time: he is both gone and may return (war); she is both gone and still here (dementia). We call this “both and thinking”, and it is as close to the truth as people with ambiguous losses can get. It also lowers stress.

After work in Kosovo and New York after 9/11, I developed guidelines to help people ease the trauma and anxiety of ambiguous loss and to help them find the resilience to live with not knowing for even a lifetime (Boss, 2006). There are no stages, phases or linearity but simply tested guidelines for therapy and intervention. One such guideline undertaken in therapy is to reconstruct one’s identity — who am I now that my spouse is missing? Am I still married if they remain missing for decades? Another guideline would be to normalize ambivalence and guilt: I wish for certainty that she is either dead or alive but then I feel guilty that I wished her dead.

How can we respond to a world that is no longer safe and predictable? With a more flexible and inclusive way of thinking about our losses, we will have the resiliency and strength to avoid sliding further toward the rigidity of absolute and authoritarian thinking — either win or lose; right or wrong; real or hoax. If we think more relationally and systemically and consider questions about ambiguous losses that may never have answers, we will be able to manage the stresses of this time. The key is to think and act less absolutely, more flexibly, because it provides us with the resilience to move forward, to work for change, and to find new hope.

About the Author:

Pauline Boss, PhD, Professor Emeritus, University of Minnesota, is a Fellow in the American Psychological Association and the American Association for Marriage and Family Therapy, and a former president of the National Council on Family Relations. Dr. Boss coined the term ambiguous loss in the 1970s and since then, developed and tested the theory of ambiguous loss, a guide for working with families of the missing, physically or psychologically. Her research and clinical work are summarized in the widely acclaimed book Ambiguous Loss: Learning to Live with Unresolved Grief (Harvard University Press, 1999/2000). Her other books include Loss, Trauma, and Resilience: Therapeutic Work with Ambiguous Loss (W. W. Norton, 2006), Loving Someone Who Has Dementia: How to Find Hope While Coping with Stress and Grief (Jossey-Bass, 2011), and The Myth of Closure: Ambiguous Loss in a Time of Pandemic and Change (W. W. Norton, 2022). For more information, see www.ambiguousloss.com.

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Acknowledgements:

A special thanks to Martin Goldstein for his support and collaboration on this piece.