What Is Ambiguous Loss? How Does It Relate to Brain Injury?

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.

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.
Posted on BrainLine July 30, 2012.

Produced by Victoria Tilney McDonough, Justin Rhodes, and Ashley Gilleland, BrainLine.

About the author: Jeffrey Kreutzer, PhD

Jeffrey Kreutzer, PhD a Professor of Physical Medicine and Rehabilitation, Neurosurgery, and Psychiatry at VCU. He serves as Director of Virginia's TBI Model System, a position he has held since 1987. He also coordinates VCU Health System outpatient services for families and persons with brain injury.

Dr. Jeffrey Kreutzer