Grief, Ambiguous Loss, and Trauma: A Puzzle with Pieces Missing
by Amy Tilley, PsyD
Grief can be complicated, confusing, physically, mentally, and emotionally draining. Grief can be difficult to work through. It can also provide a sense of closure and bring a sense of relief…relief that your loved one is no longer suffering, no longer in pain, and is fully healed in mind, body, and spirit. If you have ever experienced the death of a friend or family member, you can probably relate.
Elizabeth Kubler-Ross defined the stages as: denial, anger, bargaining, depression, and acceptance. The stages represent a non-linear process for individuals to process their thoughts and feelings about a particular loss that they experience. Everyone is unique and will experience these stages in their own way, and there is no timeline for how long each stage lasts. Going through the stages of grief is like riding an ocean wave. Some days the waves are huge and disruptive to our daily lives, other days they are calmer and provide a sense of closure and healing as we remember our loved one who died.
What about the experiences where there is a sense of anticipatory grief? Situations where your loved one is still physically present but not quite the same person that you knew them to be for so long? In the last year and a half, I have experienced it on a personal level and had no idea what it all meant. I began to wonder what I was experiencing and if there was an answer.
Through doing my own work, I learned a new term: ambiguous loss. Pauline Boss coined the term in the 1970s, after working through her own familial relationships and growing up as an immigrant with aging parents. Ambiguous loss is its own form of a traumatic experience because it does not have a clear resolution, there is some unknown to what the future will bring with the relationship that you have with your loved one. It is a type of grief with no clear resolution or closure, occurring when a loved one is either physically absent but psychologically present (e.g., missing person, deployment) or physically present but psychologically absent (dementia, addiction).
The second type is what I have been focusing on in the past year. Overnight, in January 2025, my family was thrust into the world of loving someone with early-stage dementia. In the months leading up to January 2025, I noticed a few small changes when I was having conversations with my mom…repeating the same phone calls for a few days in a row, comments of “oh, I didn’t remember telling you that,” forgetting what day of the week it was. I kept note of these conversations and talked with my dad about what he was seeing and experiencing at home. Then the fateful day in January 2025 happened when the doctors diagnosed my mom with dementia. Gone was her short-term memory. That has been the biggest change in my mom. When I call her, she has no memory of what we spoke about the day before, and sometimes still doesn’t know what day of the week it is. Her long term memory remains solidly intact, for which I am grateful. I have changed my daily phone conversations to memories of the past, and having her help me with tasks that I know she can still do well. I can hear her light up when she tells me how long to cook a certain meal or recalling a family vacation that we took decades ago. She continually asks the same five questions every phone call, and cares deeply about my well-being and how I am doing day to day, that has not changed. Mom is still here, but not quite the person that I know her to be…and the change has been immediate and drastic.
There are so many questions that can come up in the relationship between you and your loved one, and that person may not be able to answer them for you. Working through my own process led me to learn that ambiguous loss is traumatic and can create a mental and emotional impact and alter daily life. It can lead to many symptoms, such as unresolved grief, frozen grief, and can feel like the family unit is paralyzed and must now function differently than before.
There is hope and ways to cope with ambiguous loss. First, acknowledge that the ambiguous loss is real, even though your loved one is still with you. Life will be different and validate that the day-to-day that you are used to is no longer the same. Find meaning in your relationship and create new memories. Take time to process and adjust to a new identity. My dad, brother, and I are now caregivers, something that there is no guidebook for, and we are learning to walk a road of uncertainty. Get support: find a therapist or a peer group that you can talk with. Peer groups are wonderful because they are a group of people with similar lived experience and can walk with you through difficult times. Many of these are online, so you can access them anytime, anywhere.
Grief and loss come in many shapes and sizes. Ambiguous loss is one of these shapes and sizes, for which there is no answer key, and missing puzzle pieces that you may never find. It is not an easy road to travel on. There is no closure and comes with many thoughts and feelings. My hope is that you find and utilize resources that are helpful to you and your family and that you can create new and meaningful memories as you navigate through this journey with your loved ones.
