Ambiguous Loss and Disenfranchised Grief

Grief and Loss Weekly Reflection Paper by David Tillman – October 17, 2013
United Theological Seminary, New Brighton, MN 55112
Class: Pastoral Care in Grief and Loss as taught by Dr. Trina Armstrong

Key issues:

1. Ambiguous Loss – Learning to Live with Unresolved Grief – by Pauline Boss, (Harvard University Press, Cambridge, MA, 1999).
   
   1. Perceiving ambiguous loss
      1. “The loss is confusing, people are baffled and immobilized. They don’t know how to make sense of the situation.” (p. 7)
      2. “The uncertainty prevents people from adjusting to the ambiguity of their loss by reorganizing the roles and rules of their relationship with the loved one, so that the couple or family relationship freezes in place.” (p. 7)
      3. “People are denied the symbolic rituals that ordinarily support a clear loss – such as funeral after death in the family.” (p. 8)
   2. Kinds of ambiguous loss
      1. “Physically absent by psychologically present, because it is unclear whether they are dead or alive.” (8)
      2. “Physically present but psychologically absent. This condition is illustrated in the extreme by people with Alzheimer’s disease, addictions, and other chronic mental illnesses.” (8)
   3. The family stress perspective
      1. “Stress is simply caused by change-or the threat of change-in the composition of family.” (21)  
      2. “Persistent distress is not good for any individual or family.” (22)
      3. “When working with families suffering ambiguous loss is that information should be shared with them, even if that information is ‘I don’t know what the outcome will be.” (23)
      4. “I assume the ambiguous loss can traumatize…[example] PTSD…These events were never resolved and thus are continually re-experienced even years after the original event.” (23-24)
   4. “Ambiguous loss results not only from chronic mental illness but also from unclear goodbyes in daily life.” (56)
   5. “Ambivalence results from mixing the elements of cognition and emotion. Thus from this perspective, ambivalence can result from the ambiguity of not knowing who is included in the structure that is supposed to be one’s family.” (62)
   6. “Denial is a problem when, in its extremes, it prevents a transformation that would allow all those family members still present to move forward in their lives.” (86)
   7. “To regain a sense of mastery when there is ambiguity about a loved one’s absence or presence, we must give up trying to find the perfect solution. We must redefine our relationship to the missing person. Most important, we must realize that the confusion we are experiencing is attributable to the ambiguity rather than to something we did-or neglected to do. Once we know the source of our helplessness, we are free to begin the coping process. We assess the situation, begin revising our perceptions of who is in the family and on what basis, and gradually reconstruct family roles, rules and rituals. We feel more on charge even though the ambiguity persists.” (107-108)
   8. How families gain meaning from ambiguous loss
      1. “The first factor is family of origin and early social experiences…learn about the [family] rules, roles and rituals for making sense of the loss ” (120)
      2. “Also influenced by their spirituality…people often tell me they find peace and strength in their spiritual beliefs.” (123)
      3. “Another factor influencing how people make sense out of ambiguous loss is their way of thinking. Are they optimistic or pessimistic?” (124)
      4. “People’s view of how the world works influences how they find meaning in ambiguous loss…fair and just…[or] judgment and blame.” (126)
      5. “Why did this happen?…we must be prepared to look beyond the neat equation of cause and effect and learn to live with uncertainty.” (126)
   9. “Self-blame is dysfunctional because it prevents us from moving on with our lives. If we can’t forgive ourselves-or others-we ruminate about the past; there is no closure. We cannot grieve.” (128)
   10. “Family members often struggle with ambiguity even longer that the patient because those left behind must continue to make some sense out of their loss.” (136)
2. Introduction to Disenfranchised Grief – by Kenneth J. Doka, (Research Press Publishers, Champaign, Illinois, 2002)
   
   1. Disenfranchised grief – “Someone has experienced a loss…but the survivors {or person(s)] are not afforded the ‘right to grieve’…So, although the person experienced grief, that grief is not openly acknowledged, socially validated, or publicly observed.” (5)
   2. “Every society has norms that frame grieving…when loss occurs, the grieving rules include not only how one is to behave but also how one is to feel and think.” (6)
3. Disenfranchised Grief Revisited: Discounting Hope and Love – by Thomas Attig, (Oxford University Press, New York, 2004).
   
   1. “Disenfranchisement of grief is a serious social failure in several distinct respects. Some have urged that it is a failure of empathy, which it surely is. But it is not merely that; it is more deeper and serious. Disenfranchisement of grief is a political failure involving both abuse of power and serious neglect. And it is an ethical failure to respect the bereaved both in their suffering and in their efforts to overcome it and live meaningfully again in the aftermath of loss.” (200-201)
4. Disenfranchised Grief: The loss of an adolescent romantic relationship – by Margaret Kaczmarek and Barbara Backlund, (Article: Adolescence, v26 n102 p253-59 Sum 1991.)
   
   1. “Loss of a romantic relationship constitutes a major life change.” (1)
   2. “Adolescence is a period of transition and stress. Developmentally it is a period of emotional separation from childhood and family of origin when attachment to peers becomes a priority…identity vs. role confusion and intimacy vs. isolation.” (2)
   3. Romance: an attachment process (2)
      1. Secure attachment – “is a product of consistent, satisfying care and consequently expects to establish a fulfilling romantic relationship.”
      1. Avoidant attachment – “is a product of rejecting parenting and is pessimistic about finding a satisfying romantic relationship.” (2)
      1. Anxious/Ambivalent attachment – “is a product of inconsistent parenting and believes that it is rare to find “true love.” (2)
5. Pet loss and disenfranchised grief: implication for mental health counseling practice – by Millie Cordaro, (Article: Journal of Mental Health Counseling (2012) 34 (4): 283–294).
   
   1. Disenfranchised grief: quiet suffering – Humphrey’s (2009) three reasons
      1. “The relationship is not recognized by society.” (287)
      1. “The griever…is not socially recognized as a person capable of grieving.” (287)
      1. “When death is not recognized as a genuine loss.” (288)
   2. Neimeyer and Jordan (2002) empathic failure within four systematic levels
      1. Self with self – “denying or minimizing their own grief.” (288)
      1. Self with family – “family members disregard [general family] grieving patterns.” (288)
      1. Self with the larger community – “mismatch between the depth of grief of a bereaved pet owner experiences and the community’s expectation for how individuals should react to losing a pet.” (289)
      1. Self with transcendent reality – “indicates a spiritual disenfranchisement…reconciling a pet’s afterlife within various religious structures.” (289)
   3. “An important objective of grief counseling for pet loss is to open up opportunities to meaningfully mourn the deceased pet.” (290)

How has the reading affected your understanding of grief and loss? From these reading I realize how much ambiguous loss I have had in my life and where I can find it in my family of origin. Kaczmarek and Backlund’s article on romantic love helped me see more clearly in my adolescence how my early romantic relationships helped me separate from my family of origin and my childhood. Yet at the same time being in relationship with my girlfriend added its own emotional challenges. It brought up identity and role issues that I worked through back then and I still continue working through. I see better now that my romantic breakups have left some ambiguous losses, to greater or lesser degrees, that I am still grieving. The loss of what could have been.

How will you apply what you have learned in your ministry setting? As I talk with people I will be mindful of the ambiguous grief that may be part of the story they are sharing. Also I will be more aware of how important it is to recognize ambiguous losses and the value of talking about them, either individually or in groups, to help facilitate the healing process.