The Aching Difference Between Physical and Psychological Presence After TBI

Dr. Taryn Stejskal explains the concept of ambiguous loss — the feeling of being stuck when a loved one is physically present but psychologically absent or different.

See more of Dr. Taryn Stejskal's videos here.

Ambiguous loss is an incredibly helpful concept in the realm of brain injury. Both dementia and Alzheimer's, which are thought of more as an acquired brain injury, and also within the realm of traumatic brain injury. So, this was a concept that was developed by Pauline Boss, and she was at the University of Minnesota at the time, and she came up with this idea that when there's indifference between physical and psychological presence, that this creates a sense of ambiguity for people. So, there are two ways that ambiguous loss can manifest itself. On the one hand, a person can be psychologically present, but physically absent, and Pauline Boss talks about this psychological presence, but physical absence in the sense of immigrants who have maybe left their homeland with no ability to return. Their family members and that geography is very psychologically present for them, but obviously physically absent. It's also applicable in the sense of missing children. You know, parents are thinking about those children. They are psychologically present, but physically we don't know where they are. In the sense of brain injury, we have people being physically present, but to some extent psychologically absent, right? So, a family member or an individual physically here has woken up from coma typically-- you know, but not always--they can be physically present and still be in coma-- but yet psychologically they are very different. And so when there's this difference between physical presence and psychological presence, it creates a great deal of anxiety and uncertainty for people. We're not sure what to do with this kind of ambiguity. And so in that sense, what Pauline Boss believes is this anxiety, as she calls it, or this experience, keeps people stuck. People are not able to move forward because they're not sure whether or not to act on the physical presence or the psychological presence. Those two things are very different.
Posted on BrainLine January 8, 2013.

Produced by Victoria Tilney McDonough and Jared Schaubert, BrainLine, and Dan Edblom.