Ambiguous Loss and Mental Illness
With another holiday season upon us, I’ve been thinking a lot about families with mentally ill loved ones trying to navigate this complicated time. I was recently invited to join a Facebook group called the Treatment and Advocacy Center (TAC) Family Support Group, and this week a member posted a link to an informational presentation called “Ambiguous Loss: Living With Grief Cause by Serious Mental Illness (SMI).”
TAC is the only national 501(c)3 nonprofit organization dedicated solely to eliminating barriers to the timely and effective treatment of severe mental illnesses like Schizophrenia Spectrum Disorders, Severe Bipolar Disorder, and Major Depression (all illnesses that can and usually include psychosis).
TAC reports that an estimated 8.8 million adults in the U.S. live with a SMI—that’s 3% of our population. In Iowa, 26,951 of our residents are diagnosed with schizophrenia, and 56,352 with severe bipolar disorder. That’s over 80,000 Iowa families living with ambiguous loss and grief associated with SMIs.
My own family is one of those 80,000 working through ambiguous loss and grief from a SMI.
Not because of my relationship with my friend Chase, who I’ve written about before, but because of an extended family member also suffering from a SMI and who is in an acute mental health crisis as I type this.
So, what is an ambiguous loss exactly?
Dr. Pauline Boss, a family therapist and professor emeritus of family social science, coined the term and it’s describes it as “a person's profound sense of loss and sadness that is not associated with a death of a loved one. It can be a loss of emotional connection when a person's physical presence remains, or when that emotional connection remains but a physical connection is lost.”
It’s a loss that lacks clarity or resolution.
A person may be physically present but psychologically “gone” or forever changed by their condition (SMI, dementia, or a Traumatic Brain Injury). Or a person may be psychologically present in the hearts of loved ones but physically gone (homeless, transient, missing, imprisoned), or missing physically and psychologically both. A individual with a SMI themselves can experience ambiguous loss when they lose their plans, opportunities, relationships, and more.
What makes these losses so hard?
First, it’s difficult to describe them. It’s the loss of your former family structure and of your loved one as they were before the illness. It’s grief over what might have been before the SMI intervened. It’s the loss of safety for your loved one and maybe even yourself, the worry if a SMI might progress, and the stress about what to do or how to cope.
Second, there are no clear norms or rituals for ambiguous loss and grief. Family members and friends can feel confused or unsure about how to offer comfort or whether to get involved. When a loss occurs from age, an accident, or physical illness, grief is expected as a logical response, and we have a basic set of cultural and societal norms or rituals to give and receive support—flowers, food, visits, comforting embraces and words of shared sorrow.
But ambiguous losses aren’t marked by a distinct event or ending. They typically happen progressively, over time, and in my experience and observation, mostly alone and in private.
I’ve talked a lot about this concept with Chase, about the major losses of his family members, but also the ambiguous losses of what might have been for his family, and himself. In these moment, too, it’s been impossible not to think about what might have been for my family member, for the bright future and plans completely derailed by his SMI.
Coping Skills for Ambiguous Losses
During the especially difficult holiday seasons, TAC and Dr. Boss recommend practicing some coping skills:
Find meaning
Make notes on this question: What have I lost, and what does this situation mean to me?
Use your answers to name the ambiguous loss. Choose trusted people to talk through your experiences.
Adjust mastery
Remember that it’s normal to feel angry, sad, and confused. It’s unreasonable to think you might just “get over it” and move on. Learn to sit in a complex experience of loss with acceptance that you cannot “fix” this.
Reconstruct identity
Ask yourself: Who am I since this loss began to affect me? Where do I belong? How do I find purpose? As you seek answers, see yourself emerging as a new version of you.
Normalize ambivalence
Recognize conflicting feelings from a “both/and…” vantage point—such as feeling both cold and warm. I’m both happy and sad about . . . . Avoid judging your emotional experience as good or bad.
Revise Attachment
Let go of expectations that you might “fix” a relationship that has forever changed. Recognize that life can have depth and meaning despite ongoing grief from an ambiguous loss.
Discover new hope
Increase your tolerance for ambiguity. Choose a way to “play with ambiguity,” such as free association journaling, improvisation, or driving with no specific destination in mind.
And finally, for the other 79,999 Iowa families dealing with ambiguous loss and grief this holiday season, may we all practice these important coping skills, and maintain the traditions, big or small, that bring us joy. ~
Have a coping tip you’re willing to share? Leave a comment.
For more information about the Treatment Advocacy Center visit their website.
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