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Ambiguous loss refers to a situation where
someone is physically present but psychologically absent,
so an example would be like a person
who has Alzheimer's disease, and they look okay physically,
but in another way they're very impaired cognitively,
so they're there physically, but they're not there mentally,
and it also refers to situations which Pauline Boss studied,
wives of soldiers missing in action, and these are situations
where people went off to combat, and they disappeared.
They could have been dead.
They could have been wounded trying to get back to base.
They could have been in a prisoner of war camp.
These are situations where the person was psychologically present
in the family, still considered part of the family,
but the family didn't really know if the person was alive or dead
and so the ambiguity is--this refers to the fact
that there's a lot of uncertainty about the person.
There's a lot of uncertainty about them.
One issue that came to mind is there was a study that I've cited a lot.
It was done probably 30 years ago by a group of nurses,
and those nurses surveyed wives and mothers
of people who had traumatic brain injury and stroke,
and it was interesting because when the wives filled out the survey
about a third of them said that they were married
but had no husband, and then about a fourth of them said
that they were married to a stranger, and when I looked at that survey
I realized that Boss's theory or her ideas about ambiguity of loss
were also reflected in the brain injury literature.
In our society we have beliefs
about what needs to be done when a person dies.
We have rituals. We say goodbye.
We grieve, and what happens with ambiguous loss is
the person is still physically alive, but they're a very different person,
and the fact that they're still alive makes it very difficult
to grieve for that person that they used to be.
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Coined by Pauline Boss, PhD, "ambiguous loss" describes the grief associated with a loss of a person or relationship, in which there is confusion or uncertainty about that person or relationship ... such as a loved one with TBI who may be physically present but pschologically absent, or less present.
Produced by Victoria Tilney McDonough, Justin Rhodes, and Ashley Gilleland, BrainLine.
Jeffrey Kreutzer, PhD,
Jeffrey S. Kreutzer, PhD, ABPP, is the Rosa Schwarz Cifu Professor of Physical Medicine and Rehabilitation at Virginia Commonwealth University (VCU), Medical College of Virginia Campus. There, he is also a professor of Neurosurgery and Psychiatry. Dr. Kreutzer serves as director of Virginia's federally designated Traumatic Brain Injury Model System and coordinates VCU Health System outpatient services for families and persons with brain injury.
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