A little over a year ago, a friendship that was very dear to me came to an end. I had loved this person dearly and enjoyed the time I spent with this friend. We experienced some tremendous highs and struggled through some painful lows. We invested a lot of time, energy into our friendship. So, when our friendship was hit by a fatal blow of circumstances, the loss almost felt like a death. I turned from the path of friendship to the path of grief. To this day I still struggle with the grief of losing this friend.

The most difficult aspect of this loss was that my other friends and my family did not understand the depth of my loss. Many did not even recognize it as a loss because of its ambiguity. Because my friend was still alive, the loss was seen as uncertain or doubted because there was a possibility that we could revive that friendship. I knew in my heart that it was highly unlikely. Because of the ambiguous nature of this loss, I received very little support or comfort during my grieving process. Essentially, I was alone in my grief.

In her book, Complicated Losses Difficult Deaths, Dr. Roslyn A. Karaban writes that ambiguous losses can fall under two categories: the physical presence of the person but with psychological absence, and the physical absence of the person but with psychological presence. Here are some examples of losses for each category.

1. Physical presence of the person/psychological absence

• Chronic illness or disabilities
• Dementia
• Coma
• Addiction
• Mental illness or issues such as depression or PTSD

1. Physical absence of the person/psychological presence

• hostage
• MIA such as the emergency workers on 9/11
• Missing child
• Divorce or loss of friendship/relationship

Giving a name to this type of loss gives recognition. It can help an individual feel as if they are not suffering alone or without a cause. It can help the individual in their grief process, which sometimes can be complicated. One paramedic shares his experience with the complicated grief of an ambiguous loss. “Within a sixteen month period, I lost two of my very best friends. One friend was someone I had known since childhood. The other friend was partner on the ambulance. My childhood friend was killed in a car accident. The grief that I felt was excruciating. Some days I just felt that I couldn’t go on. But for some reason, I was able to draw a sense of peace as I went through my grief process. Nearly a year later, my friend at work and I experienced a series of circumstances that caused our friendship to die. Again I was thrown into the grief process. But, this time around it was so much more difficult and I didn’t understand why until I learned about ambiguous loss. Because I still worked at the same department as my friend, I was constantly being re-exposed to the loss. It was like I was always stuck in one phase of the grief cycle. I never felt that sense of peace that I felt when I started healing from the loss of my childhood friend. To this day, and it has been nearly two years since I lost my friend from work, I am struggling with my grief.”

It is important for individuals to understand ambiguous losses and how to cope. One of the most important reasons understanding is essential is because unresolved losses can complicate and exacerbate the grief process of future losses. For emergency service workers, ambiguous losses are pretty prevalent. Because the emergency service community experiences a higher rate of divorce, addiction, mental health issues, on the job injuries and illnesses, and the loss (sometimes tragic loss) of co-workers, it is important to learn how to pinpoint when a loss has occurred.

In the adoption community, ambiguous loss abounds.  For the child, it’s the loss of their birth parents.  For the birth parents it’s the loss of their child.  For the adoptive parent, in many cases, it’s the loss that led to the adoption process.  Having read the writings from members of each of these groups, all three experience grief that is quickly dismissed or swept under the rug, therefore making the loss and grieving more complicated.

Know that if one is faced with an ambiguous loss, there will be grieving. The individual may experience psychological, physical, social, and spiritual responses–all of which are normal responses. If the affected individual knows that someone else recognizes their loss as real and substantial, their healing might be easier.

Here are some things that an individual experiencing an ambiguous loss or a care-giver/friend can do to help with the grieving process:

• Use the Internet to find resources, support groups, and other materials that relates to the particular loss, i.e., injuries, divorce, loss of friendships.
• Write a letter to the person that is involved in your loss, then either bury or burn the letter.
• Learn to identify and express the feelings that come with the loss. Talk to friends, counselors, chaplains, and ministers. Learn to verbalize all feelings.
• Reinvest ‘empty time’ into a new project or activity, especially in ones that help others. Many grieving people have stated that helping other people is what helped them the most.
• Reinforce positive self-talk, especially in the event of consistent re-exposure to the loss. Negative self-talk will only make the experience more painful and healing more difficult.
• Create new traditions. Most individuals have some sort of traditions that they like to follow. If a friendship dies, traditions associated with that individual tend to die, too. Making a new tradition with one’s self, a spouse, or another friend can be healing and can quite possibly open the door to new possibilities.

Ambiguous losses are real losses that can cause a person to experience tremendous pain. Knowing how to spot this type of loss and how to deal with it can really change a person’s life and their outlook on life.  Since the loss of my friend, writing a letter to that person explaining my thoughts, pain, and fears has really helped me with putting a closure to that relationship. Being able to spot my particular grief and writing the letter has helped so much.