As a doctoral student in the 1970s, I coined the term ambiguous loss and have been fine-tuning the theory and its guidelines for therapy and intervention ever since. My basic theoretical premise was—and still is—that ambiguous loss is the most stressful kind of loss.
Ambiguous loss defies resolution, creates long-term confusion about who is in or out of a particular couple or family, and freezes the process of grieving. With death, there is official certification of loss, proof of the transformation from life to death, and support for mourners through community rituals and gatherings. With ambiguous loss, none of these markers exist. The persisting ambiguity blocks cognition, coping, meaning-making, and freezes the grief process.
In the early 1970s, through the Center for Prisoner of War Studies at the Naval Health Research Institute in San Diego, I interviewed wives of pilots missing in action (MIA) in Vietnam and Southeast Asia. In 1989, I met with psychologists exhausted by their work in Armenia and Azerbaijan after the Armenian earthquake. On numerous occasions in the 1980s, I met with military family personnel, rehabilitation counselors, clergy, and health care professionals to discuss ambiguous loss and trauma. In 1997, I collaborated with therapists and community leaders in the aftermath of the flooded Red River Valley in the upper Midwest. After the terrorist attacks in New York City on September 11, 2001 (9/11), and at the invitation of labor union leaders, I worked with New York therapists to help families of the missing. Today the work on ambiguous loss training and research continues and includes national and global work, for example, with Japan; Switzerland; Tbilisi, Georgia; Mexico; and the International Committee of the Red Cross (ICRC).
In my family therapy practice, I have worked since 1974 with individuals, couples, and families, most of whom had some kind of ambiguous loss—physical (as described above) or the psychological ambiguous losses of a depressed mate, a parent with Alzheimer's disease, a child with brain injury, a loved one with an addiction or other chronic mental illness, or a loved one who is changing because of aging or transitioning. From all of this work, I gained a profound respect for the many who manage to live well despite having a loss with no certainty or resolution. These people have taught me what resilience is in the face of a most difficult circumstance.
Today, the term ambiguous loss is, for now, in the general lexicon, not just for professionals but also for the general public—and arts communities. What is now referred to as "the theory of ambiguous loss" is being honed by the research of others working with people experiencing either physical or psychological ambiguous losses.
Coming Full Circle
[Portions of the following text from Loss, Trauma, and Resilience (Norton, 2006), pp. xx-xxi.]
My work in New York and Kosovo and with people affected by the [Indian Ocean] 2004 tsunami has solidified my views about including family and resiliency-based approaches in treating loss and trauma. The common focus on individual treatment and pathology after loss and trauma must be broadened to include safeguarding natural family and community strengths and rebuilding resiliency.
Working in New York after 9/11 brought me out of the ivory tower of the academic world and into the community. It pushed my feelings and my thinking to the brink. My experiences with the families of workers who vanished on that terrible day tested my assumptions—and me—more rigorously than any research test could have. The challenge was to apply the theory of ambiguous loss to this catastrophe. The work was exceedingly difficult during the first few weeks and called for personal time-outs to reflect.
On one of those early days, I looked out of the window from the 21st floor of the union building where we were working with the families. The smoke was still rising from Ground Zero. I hungered for another view, but only later did I find a more comforting one. At a friend's high-rise home in lower Manhattan, in the late afternoon sun, I saw the Statue of Liberty—the same statue that welcomed my father and my maternal grandparents into the New York harbor so long ago. I realized then that I had come full circle, back to where my family had begun life in the United States. I felt a deep calm. Hope and loss had merged for them, and now for me, too. Out of this insight came renewed strength.
Many of the families we worked with had come to this shore, like my elders, hoping for a better life. By uprooting, they, too, had lost contact with parents and siblings. After 9/11, they faced an ambiguous loss even more horrendous. Could they regain their resiliency and strength while being cut off from loved ones in faraway islands or countries? Thankfully, with family and community-based interventions, many have.