Missing in Action, Ambiguous Loss, and Grieving When Someone Is Still Alive

When my marriage was coming to a painful end, I remember having many laborious, often traumatic conversations with my now ex.  During one phone call I remember well, I said, "I thought our marriage had chronic asthma, but you knew we had stage 4 cancer and you didn't tell me." 

Having worked in hospice and being a grief therapist, I look at many things through a lens of disease, grief and loss. 

And what I was grappling with at that point is the same thing many of us grapple with - our human need to not only grieve, but understand when to grieve, and also to know just what it is we are grieving.  When it comes to loving someone, we are wired to be hopeful.  And when we are wired to be hopeful, we are also wired to stay in denial as long as possible when it comes to grief.

What I struggled with in the waning years of my marriage, and what many people struggle with in a variety of circumstances, is the problem of  ambiguous loss - a very grief therapist term.  The term ambiguous loss was coined in the 1970s to talk about the challenges of grief for family members of service members MIA in Vietnam.  Should you grieve if someone might still be alive?  Can you grieve if you haven't seen your loved one's deceased body?  Are you a bad person if you 'give up hope?'  How do you go on with your life, when part of your life is on hold?

This is the challenge of acceptance, when you don't know if you have really lost someone.  My bias plays out this way:  there are many ways relationships are lost - not just through death.  And, the painful puzzling to understand that the relationship is gone or has shifted in some profound way and will never be what it once was - that is the ambiguous loss. 

I see ambiguous loss and a feeling of being stuck between hope and grief in a few typical scenarios:
when someone we love has dementia, when someone we love is an addict, and when someone we love has vastly different wants and needs for a relationship, but hasn't clued us in on that. 

Dementia is just one of several medical condition that robs someone's mental/emotional capacity.  Many times these illnesses have a slow onset, and years of decline - a sense of losing someone you love in a thousand pinpricks.  I remember a husband I supported in hospice...his wife was finally in the end stages of her decline with dementia and he'd been her caregiver for over ten years.  In the last couple of years, the family moved her into a residential dementia care facility and he visited her every day.  In the meantime,  he developed a romantic relationship with another woman.  This romance did not interfere with his care  of his debilitated wife, but his adult kids were terribly angry with him.  This whole situation was rife with ambiguous loss.  Dementia can be particularly hard to accept and grieve, because is varies day to day and moment to moment in the beginning stages.  Your mother might be confused when you sit down to lunch, but a few minutes later seem just like herself.  Family members often experience a lot of anger and frustration at this stage.  First, the anger may be at the person with dementia.  The anger itself is a part of grief, perhaps it's even a form of bargaining, as if subconsciously we think, 'If I get mad at you, it will be like a bucket of ice water thrown in your face, and you'll be shocked into being yourself again.'   As time goes on, the anger may be at other family members.  In this situation, the husband realized he did not have the partner he once had, the wife.  He grieved that relationship.  His kids weren't in the same spot and didn't want him to be where he was either.  It's tough for everyone.

Not totally unlike dementia,  is grieving someone who is in addiction.  Their body is still there, but as addiction progresses you lose that person in deeper and more profound ways.  Here's an amazing video that my kids were shown in elementary school as part of their drug and alcohol awareness education  Nuggets  If you've ever loved someone in addiction, you will recognize this terrible representation.  If you've loved someone with addiction, denial can be part of your own disease.  What does it mean to 'accept' the addiction or the addict?  Does it mean giving up hope?  Does it mean putting up with stealing, lying, cheating and other poor treatment?  (I'd say an emphatic 'no' to the last one.)

Much of 12-step literature uses the language of 'detaching', which to my way of thinking is similar to grieving, accepting, letting go.  If you are trying to accept that the addict you love is missing in action, you might hear this, "Detach with anger or detach with love, but just detach."

A lot of clients ask me 'yes, but what does that mean?'  It means practicing and practicing and practicing new ways of interacting and thinking.  It means not offering help or solutions, whether they are explicitly asked for or not.  It means giving up your own ego because the ego will tell you, 'I'm the one person who can probably help.'  Instead, it means saying, "I know you will figure this out," to the person who is in addiction.  One day, after practicing this for years, you might wake up and feel not responsible for the addicted person's actions, successes, failure, or death.  All the while, you will be straining in ambiguous loss, but you will be learning to ACCEPT that the person you love is both there and not there.  Not unlike a person with dementia.

And this leads me to the  most frequent ambiguous loss I see.  The type of loss where it is extremely helpful to bear in mind this pithy statement found in the journal of a dramatic 23 year old Special Events Coordinator circa 1995.  (Me)  No matter what people say, they do what they want to do.

You see, one of the greatest causes of suffering in ambiguous loss that I see with clients are people who are confused/in denial because they are dealing with someone they have loved who is MIA, but present in their day to day life in the role that they have always been in.  That person can be a spouse, a parent, an old friend.  That person is saying, "We're good. I love you."  But that person is not showing up in ways that feel like care or love.

I recently re-watched When Harry Met Sally, and Carrie Fisher's character has been having an affair with a married man for years, though she is single and longing to be married herself.  She says to Meg Ryan's character during several scenes, things like this, "I saw his credit card bill.  He just bought his wife a new coat.  He's never going to leave her.'  And Meg Ryan affirms, 'He's never going to leave her.'  Carrie Fisher's character is in denial.  She is suffering from ambiguous loss.  The guy is both there and not there for her.  Her problem is denial and his problem is being a jerk.  He's a jerk, because he's trying to have it both ways and isn't honest with her about his wants and needs.  I see this all the time in the work I do.  It's not just with married people - people can be motivated by all kinds of selfishness. 

There is also ambiguous loss in relationships where one person's wants and needs are simply vastly different from the another's, but this is a change from the way the relationship once was.  I see this with adult children and their parents, as one example.  Some adult children have the hope and desire for their parents to be present and involved with their lives and the grandkids' lives.  Yet, the parents have the expectation that this is 'their time' to do what they want.  It can also be vice versa - where parents have hopes for a certain kind of closeness with their adult kids but the adult kids have really created a life separate from the 'childhood' life.

I also see this with friendships, whether it be my middle school-aged child or in my own life (not to mention stories I hear from clients).  While it might make things clearer if we could all be so honest with ourselves and friends to be able to say things like, "I'm just needing a little space in our friendship right now."  Or, "My priorities have shifted since my kids are in college, and I want to spend my time in other ways,"  I am not always sure the types of hurt we would endure would be worth it.  Sometimes, we might withdraw from friendships or experience others' withdrawing from us.  Should we take it personally?  Should we grieve?  Maybe the other person doesn't even notice?  It's ambiguous and that makes it highly uncomfortable. 

Unlike with dementia or addictions, sometimes we will not have specific answers for why a relationship changes.  Why someone we love goes MIA.  That's another way that working in death, dying, and grief have influenced me - I accept and encourage you to accept, that sometimes there is no knowable reason WHY.  

Now, I am - Holy Crap! - twice the age I was when I wrote, "No matter what people say, they do what they want to do."  It's true that I have a more nuanced understanding of human relationships, so while overall, I think it's a good rule of thumb, let me now say it like this: 

Try to be straightforward in your communication with all people and ask for what you want and need from others.  Take people at their actions.  Listen to your intuition.  Deep down, do you believe this person has good intentions and loves you?  If so, be patient with the ebb and flow of life.  If not, your loss is no longer ambiguous.  It is time to grieve.  Let yourself do that and then re-focus on relationships that are fulfilling for you.

Maybe now you know that you are trying to grieve an ambiguous loss.  Maybe having the words helps.  There's really no answer for grief, no cure (though some people say time).  It's a natural process and individual to each person.  It makes me think of a  friend from high school whose mom has dementia.  He's beginning to use this experience in his act.  He's getting a good response.  How do we grieve?  We accept.  We share.  And we laugh.  We have to.