complicated grief and ambiguous loss

A friend sent me a link to the June 23 episode of the NPR program, On Being. Krista Tippett interviewed Pauline Boss, who wrote Ambiguous Loss: Learning to Live with Unresolved Grief.

Boss uses "ambiguous loss" to refer to the loss of people we lose without being able to say "They are gone." Families of Alzheimer's patients, for example, or families of soldiers missing in action mourn the loss of someone before the person is gone or without knowing if that person is gone.

Because of a natural disaster like a tsunami or because of an event like 9/11, people mourn the loss of someone who is dead--but without a body to identify.

Krista Tippett called it that trauma of people not being able to say goodbye, not being able to bury their dead.

From the interview:

MS. TIPPETT: One thing that you say is that the kind of grief that's involved in ambiguous loss is distinct from traditional grief. So how is it different? 

DR. BOSS: Yes. Well, with ambiguous loss, there's really no possibility of closure. ...

Not even, in fact, resolution, whichever word you prefer to use. And therefore, it ends up looking like what the psychiatrists now call “complicated grief.” 

MS. TIPPETT: Right. 

DR. BOSS: And that is, in fact, a diagnosis, complicated grief. And it's believed that it requires some kind of psychiatric intervention. My point is very different, that ambiguous loss is a complicated loss, which causes, therefore, complicated grief, but it is not pathological. Individually, that is. It's not a pathological psyche; it's a pathological situation. And as clients frequently say back to me, “Oh, you mean the situation is crazy, not me,” that's what exactly what I mean. 

It's an illogical, chaotic, unbelievably painful situation that these people go through who have missing loved ones, either physically or psychologically. And if they have some symptoms of grief that carry on, let's say even for five or ten years, if it's a caregiver of an Alzheimer's patient or the parent of a missing child, there is nothing wrong with them. That is typical. That is to be expected, that they would grieve along the way for the various things that they are missing. For example, if a child is kidnapped, they may have an extra grief when this child's friends are graduating. 

Complicated grief. Families of inmates will recognize this. How to mourn the  absence of someone when people around you will not talk about him?

If you know someone who has a family member in prison, recognize that what you see in them could be complicated grief.

DR. BOSS: And in order to understand this, though, we have to make a difference between depression and sadness. 

MS. TIPPETT: Right, right. To say that sadness is not depression. 

DR. BOSS: And so far, that hasn't been made. [laughs] 

MS. TIPPETT: Right. 

DR. BOSS: Yes. Depression is an illness that requires a medical intervention. It's the minority of people who have depression. And yet, with the ambiguous loss of let's say Alzheimer's disease and 50-some other dementias, caregivers are said to be depressed. Most of the caregivers I have met and studied and treated are not depressed; they're sad. They're grieving. And this should be normalized. And sadness is treated with human connection. 

MS. TIPPETT: Mm. So, one of the things that you say — and this makes so much sense, but it's the kind of thing that makes sense — we have to say it — that people can't cope with the problem until they know what the problem is. 

DR. BOSS: Yes. 

MS. TIPPETT: You've said with ambiguous loss that once people have a name for it, just that... 

DR. BOSS: That helps. 

MS. TIPPETT: ...that the stress level goes down a bit.

Like those who lose loved ones to  illness, accident, or age, those who lose someone to prison will appreciate a friend who recognizes that their lives have been turned upside down, that they are experiencing a complicated grief.

Let them grieve. Keep them company.