Ambiguous loss (Boss)
A loss with no clear ending, so grief has nowhere to settle. Boss describes two kinds: a person physically gone but psychologically present (missing in war or a disaster, disappeared), and a person physically present but psychologically gone (dementia, brain injury, addiction, chronic mental illness).
What drives it
With no death and no return, people cannot tell whether to grieve or hope, and friends do not know whether to send a card. For identification it explains why distress can stay high for years: the situation itself stays unresolved, and the person may be coping as well as anyone could.
How it shows
Work
Carrying on at work while a husband with Alzheimer’s no longer knows you at the weekend. No compassionate leave, because nobody has died. A colleague whose brother has been missing for a year is asked every Monday whether there is ‘any news’.
Relationships
A wife who calls herself ‘married but not married’. Families arguing over whether to hold a memorial for someone missing. Grieving a parent lost to addiction while still taking their calls.
Self
Notice if you swing between hope and grief and feel guilty for both. Notice the question you can’t answer: am I still a wife, a son, a partner?
What tells it apart
Chronic sorrow and nonfinite loss (Olshansky): Chronic sorrow centers on a living loss that keeps returning, such as a child’s disability, where the person is known and present. In ambiguous loss the confusion is whether the person is here or gone, and that doubt may be the main source of pain.
Grief (complicated, disenfranchised, anticipatory): Anticipatory grief starts before an expected death and has an end in view. With dementia the two may overlap, and ambiguous loss is more likely when the person is physically there, the relationship already feels over, and there is no sense of when it will end.
Prolonged grief disorder (ICD-11, DSM-5-TR): Prolonged grief is diagnosed after a death. With a missing person or a living loss, high distress for years may be a fitting response to a situation that has not ended, and is less likely to fit that label.
A test
Ask whether the person can say plainly that they have lost someone. If the honest answer is ‘yes and no’, and the distress rises with each sign of hope or decline, ambiguous loss may be what they are living with.
Questions to carry
- When someone last asked me for news, what did I want to say and hold back?
- Which part of me is still waiting, and which part has already said goodbye?
Go deeper
- Read: The Other Side of Sadness, George A. Bonanno, 2009, revised 2019. Written for readers by a psychologist who has followed bereaved people for years. He questions the idea that grief moves through set stages and argues that most people come through a loss with more resilience than expected. Much of it rests on his own group's studies.
How strong the research is
moderate. In 70 family caregivers of people with dementia (Boss, Caron, Horbal and Mortimer, 1990), those who saw the person as psychologically gone from the family reported more depression, and the severity of the dementia did not predict it. That study was correlational, so it shows a link and leaves the direction open. A 30-year review (Carroll, Olson and Buckmiller, 2007) found 37 studies of boundary ambiguity across 11 areas, among them families of men missing in action, death, divorce, stepfamilies and caregiving.
Where it comes from
Pauline Boss, from her 1970s interviews with wives of pilots missing in action in Vietnam and Southeast Asia, through the Center for Prisoner of War Studies in San Diego. Ambiguous Loss: Learning to Live with Unresolved Grief, Harvard University Press, 1999
On the family tree: Pauline Boss