About Pauline Boss
Five years ago, the idea of ambiguous loss-- an unclear loss that defies closure-- was introduced to the general public (Boss, 1999). Here is an explanation of its application:
My basic theoretical premise is that ambiguous loss is the most stressful kind of loss. It defies resolution and creates long-term confusion about who is in or out of a particular couple or family. With death, there is official certification of loss, and mourning rituals allow one to say goodbye. With ambiguous loss, none of these markers exist. The persisting ambiguity blocks cognition, coping, meaning-making and freezes the grief process.
The theory of ambiguous loss is based on decades of research and the work of professionals who treat families traumatized by war, terrorism, natural disasters, and chronic illnesses and disabilities. My ideas have also been honed by decades of clinical work with couples and families, as well as from my personal experiences with ambiguous loss. In the early 1970s, through the Center for Prisoner of War Studies at the Naval Health Research Institute in San Diego, I interviewed wives of pilots missing in action (MIA) in Vietnam and Southeast Asia. In 1989, I met with psychologists exhausted by their work in Armenia and Azerbaijan after the Armenia earthquake. In 1997, I met with therapists and community leaders in the aftermath of the flooded Red River Valley in the upper Midwest. On numerous occasions I have met with military family personnel, rehabilitation counselors, clergy, and healthcare professionals to discuss ambiguous loss and trauma.
After the terrorist attacks on 9/11 and at the invitation of labor union leaders, I worked with New York therapists to help families of the missing. I continue training therapists for this kind of work. At the invitation of the International Committee of the Red Cross (ICRC), I trained professionals and community leaders in Kosovo to work with the nearly 4,000 families with loved ones still missing since the late 1990s as the result of ethnic cleansing. In private practice, I have worked since 1974 with individuals, couples, and families, most of whom had some kind of ambiguous loss-- a depressed mate, a parent with Alzheimer’s Disease, a child with brain injury, a loved one with an addiction or other chronic mental illnesses. From all of this work, I have gained a profound respect for the many who manage to live well despite an ambiguous loss with no resolution. They have taught me what resilience is.
Coming Full Circle
My work in New York and Kosovo and with people affected by the 2004 tsunami has solidified my views about including family and resiliency-based approaches in treating loss and trauma. The common focus on individual treatment and pathology after loss and trauma must be broadened to include safeguarding natural family and community strengths and rebuilding resiliency.
Working in New York after 9/11 brought me out of the ivory tower of the academic world and into the community. It pushed my feelings and my thinking to the brink. My experiences with the families of workers who vanished on that terrible day tested my assumptions-- and me-- more rigorously than any research test could have. The challenge was to apply the theory of ambiguous loss to this catastrophe. The work was exceedingly difficult during the first few weeks and called for personal time-outs to reflect.
On one of those early days, I looked out of the window from the 21st floor of the union building where we were working with the families. The smoke was still rising from Ground Zero. I hungered for another view, but only later did I find a more comforting one. At a friend’s high-rise home in lower Manhattan, in the late afternoon sun, I saw the Statue of Liberty-- the same statue that welcomed my father and my maternal grandparents into the New York harbor so long ago. I realized then that I had come full circle, back to where my family had begun life in the United States. I felt a deep calm. Hope and loss had merged for them, and now for me, too. Out of this insight came renewed strength.
Many of the families we worked with had come to this shore, like my elders, hoping for a better life. By uprooting, they, too, had lost contact with parents and siblings. After 9/11, they faced an ambiguous loss even more horrendous. Could they regain their resiliency and strength while being cut off from loved ones in faraway islands or countries? Thankfully, with family and community-based interventions, many have.
[Portions of the above text are from Loss, Trauma, and Resilience, W.W. Norton, 2006]