Unit 9 -- Ambiguous Loss and Disenfranchised Grief
Grief in a Family Context --HPER F460/F560
Goals for this Unit
In this unit, we address ambiguity in loss and the sense of disenfranchisement
that goes with this ambiguity. You have seen already in earlier units and
have become even more aware of in our class discussion, the state within
which exists after a loss is inherently uncertain. In this unit, we will
address aspects of losses that are even more ambiguous than the norm. The
grief related to these losses is likely to be disenfranchised--ignored
or minimized--and this will be explored.
Think of what the two terms we will address in this unit: ambiguity and
disenfranchisement. As you do, write down your own answers to the following
questions, and save the answers for class discussion:
- What do these terms mean to you and how do you view them in relation to loss and grief? What type of losses
would you see as ambiguous? How would you recognize disenfranchised grief?
- Both of these factors have been seen to contribute to a more complicated
grief experience for individuals. Why do you think this is?
- I'd like you to think in terms of family systems and consider how differential
grief in families might contribute to a sense of ambiguity and disenfranchisement among
Boss, P. (2004). Ambiguous loss. In F. Wash & M. McGoldrick (Eds.), Living beyond loss: Death in the family (2nd ed.) (pp. 237-246), New York: Norton.
Doka, K. J. (2002). Introduction. In K. J. Doka (Ed.), Disenfranchised grief: Recognizing hidden sorrow (pp. 3-11), Lexington, MA: Lexington Books.
Werner-Lin, A., & Moro, T. (2004). Unacknowledged and stigmatized losses. In F. Wash & M. McGoldrick (Eds.), Living beyond loss: Death in the family (2nd ed.) (pp. 248-271), New York: Norton.
Van Reken, R. E. (1988). Letters Never Sent. Indianapolis, IN: "Letters." (chapters 8-18, pp 49-165).
The following resources contain a wealth of information on losses that are often experienced as ambiguous/worthy of grief. Focus on reading the stories and poetry for this class
A theme that has recurred throughout this course is that we experience
loss and grief in a social context. Even when we do so in a more solitary
fashion, we learn the "ways of grief and mourning" from others,
be it our families, those who have also experienced a loss, or others in
our social network.
As I describe this and we discuss it in relation to ambiguous loss and
disenfranchised grief, I will be using ideas from construct psychology.
As you'll recall from my article (which I've asked you to re-read from
last week), this perspective holds that reality is not passively experienced
"as it is." Instead we actively construct meaning and we perceive
this to be reality. As social animals, we use the social world around us
to confirm that our reality is the reality that others sense and are experiencing.
In effect, we establish an objective reality, which we see as independent
of ourselves, by confirming it with other perspective takers. The importance of this social construction can not be overemphasized.
The Role of "Family" in Constructing Reality
The family plays an important role in the construction of reality. Starting
in infancy, our family serves as a primary source of information on how
to interpret the many stimuli we encounter in our experiential world. From
this point on, family members co-exists in an interactive system, confirming
and disconfirming views held by each member (Note that it is not necessary
for this to be an active confirmation. We may passively observe others
and then make assumptions about the meaning of their statements and behaviors.).
In this confirmatory system, behaviors are interpreted, comments are made
and assessed, all within the context of each member's assumptions. In fact,
even though family members may not share a reality in the sense that their
thoughts match, their need to believe that they hold a shared view appears
to be strong. An example of the response when this "shared view"
is confronted can be found in the tremendous difficulty bereaved parents
face in accepting that their spouse's grief different from their own ("We've
lost the same child. Why are you behaving so differently?"). This
differential grieving is the norm rather than the exception, yet is difficult
for many bereaved individuals to accept, as I discuss in my paper.
I would like to point out the importance of remembering that reality construction
is an ongoing process and that one's family is involved in this process.
Both their involvement and the process are not restricted to a loss
How Does this Relate to Ambiguous Loss and Disenfranchised Grief?
At the time of a loss, people are confused and overwhelmed. The loss they
have experienced may overwhelm them and their expectations about life.
The situation can be made more complicated if there is ambiguity about
the death. Ambiguous losses are those that lack clarity and can lead to
sharply different assessments of exactly who or what has been lost. There
may even be some question as to whether or not a loss has occurred, or if this is a death that should generate deep emotional response. With
uncertainty about how to respond, members of the social network often do
nothing. They may even avoid the bereaved because they (the network members)
are uncomfortable with the uncertainty, or put off by intense emotions resulting from an "insignificant" loss.
I'll provide a list of losses that often are experienced as ambiguous ones,
but the list can be extended much further:
- Infertility, which may not even be noticed by others, but, at least for infertile women, the monthly menstrual cycle acts as a painful reminder of this loss
Perinatal death, in particular death during pregnancy
- Cases where a pregnancy has been terminated. Although most women
who elect to terminate a pregnancy appear to experience relief as their
primary emotion, others, especially those who terminate because of a fetal
anomaly, experience grief at the death of their child.
- Birth mothers who give their child up for adoption often experience
recurrences of deep grief long after they have given their child up. This
commonly reaches its greatest intensity on the child's birthday.
- Children who were adopted describe grieving over their fantasy parent-child relationship that might have been.
- Adoptive parents who describe grieving their "wished for" biological child, and may re-experience grief if their child decides to seek out her/his biological family.
- Couples who are struggling with infertility often describe a
sense of isolation (sometimes from each other). Their loss, if recognized,
commonly is minimized by others ("Just relax. I know someone who...").
- As we discussed earlier in this course, the grief of children
is not interpreted accurately or accepted as real by adults.
- The death of a pet, often seen by others as "just an animal". Yet, as we discussed earlier in this class, this may be a particularly significant loss for a child or an elderly person.
- Losses that are so "large" that they overwhelm the imaginations
of others, such as suicide or murder. Such a loss overwhelms everyone
involved, but the tragedy is that this is a time when the bereaved most
need their loss recognized and, at the same time, the time when their social
network is most likely to avoid any and all discussion of the person who
has been lost.
- Alzheimer's Disease, which may create a situation in which a family member, although alive, may be seen as "dead" by some family members, because the person they know and love is seen to no longer inhabit the body of their loved one.
- The death of an ex-spouse or a lover.
- AIDS deaths certainly are socially ambiguous. Questions about
"deserving and undeserving" victims of the disease and the legitimacy
of seeing the bereaved partner of a gay victim of the disease as a "bereaved
spouse" are examples of the uncertainty related to these deaths.
- Phantom losses, which are losses that occurred before you were born
or had the opportunity to meet the person, but have a significant effect on
your life, like the death of a grandmother before your birth or the death of a
father-in-law before you met your spouse.
- Finally, a curious ambiguity surrounds multiple losses, particularly
if they are serial losses, taking place over a period of time. The
bereaved may come to be seen by others as "marked" or "cursed"
(or may feel they are seen this way by others.
Other losses, not those to death, can be experienced as ambiguous ones. Included in such a list would be:
- In the case of divorce, when a parent stops his/her visitation,
and, essentially, abandons the family, children experience grief.
- When their child gets involved with drugs or criminal activities,
parents may feel they are being blamed for their child's choices. They
grieve the loss of the child they had had and/or hoped for, but do not feel
supported in this grief.
- When an illness or condition is invisible but disabling
(e.g., diabetes or the result of an injury), with each new limitation comes
- One's own deterioration or the deterioration of a loved one can result in unresolved grief
- Caregivers can be hidden grievers, too. What has been viewed
as burnout may, in fact, be unresolved grief at ambiguous loss.
- Children often experience, but even adults can experience grief at moving to a new home, in a new community, because there are so many small losses related to the loss of feeling anchored in a community.
- Mental illness and having a loved one with mental illness, which may involve a cycling between periods of relatively typical functioning interspersed with periods of serious to profound recurrence of the mental illness.
- It is possible to experience losses in childhood that are not reconciled and continue to recur and affect one's functioning in adulthood, as described by Ruth Van Reken in her book on her life as a missionary kid (MK).
An important factor in the resolution of grief is social support from others.
The bereaved need support, not only for the reality of the loss, but for
the validity of their grief, and of themselves as legitimate grievers.
As Fowlkes (1991, p. 532) wrote, "Because loss entails a loss of self-validation,
the starting point for recovery is the validation of the loss itself."
Ambiguous losses receive little or no public recognition, and if members
of the social network are unable to recognize the loss as real, they will
not be able to validate the grief of the bereaved. Others may find providing
support difficult to do, since people are more comfortable with "normal"
rather than what is perceived as "abnormal" losses and grief
responses. Thus, an ambiguous loss may be experienced as irreconcilable.
This may, in turn, lead to disenfranchised grief, which will be discussed
later in this "lecture.
Another way to approach ambiguity in losses is detailed in the article
you read that was written by Pauline Boss. Using a family systems approach,
she proposed that a "(l)ack of clarity about the loss of a family
member generates confusion and conflict about who is in and who is out
of the system." This uncertainty is based on a conflict in
the physical and psychological presence of a family member in the system.
A family member might be physically present but psychologically absent,
as with Alzheimer's disease, or may be psychologically present but physically
absent, as when a child is abducted.
- The higher the boundary ambiguity in the family system, the greater
the helplessness (low mastery) and the greater the likelihood of individual
and family dysfunction (depression and conflict).
- In the short run, family boundary ambiguity may not be dysfunctional.
- If a high degree of family boundary ambiguity persists over time, the
family system is at risk for becoming highly stressed and subsequently
- Families in varying cultural contexts differ in how they perceive their
family boundaries -- even after similar events of loss or separation.
Disenfranchised grief is the result of a loss for which they do not have
a socially recognized right, role or capacity to grieve. These socially
ambiguous losses are not or cannot be openly mourned, or socially supported.
Essentially, this is grief that is restricted by "grieving rules"
ascribed by the culture and society. The bereaved may not publicly grieve
because, somehow, some element or elements of the loss prevent a public
Disenfranchised grief occurs in three primary ways. You may note that some
of the examples also were noted under ambiguous losses:
- The relationship is not socially recognized. The relationship
is not based on recognizable kin ties (the death of a friend), may not
be publicly recognized or socially sanctioned, (a partner in a gay or lesbian
relationship), the relationship exists primarily in the past (ex-spouse)
- The loss is not socially recognized or is hidden from others. Not
socially recognized losses include perinatal losses. Hidden losses include
abortion (politicization of loss), the loss of pet (fear of ridicule),
and losses that result from causes other than death.
- The griever is not socially recognized. This may include those
who are not socially defined as capable of grief: very old and very young
and the mentally disabled.
- Circumstances of the death or deaths that contribute to stigma and negative judgement by others. Forms of death that at least appear to have an element of choice or poor decision-making would fall into this category. Suicide, abortion, death as a result of AIDS, and fatal drug overdose are all examples of this contributor to disenfranchisement.
- The ways individuals grieve. Each culture provides a range of acceptable behavior after a loss, and any dramatic exceptions to these “grieving rules” will be met with anything ranging from concern or irritation through to censure.
Essentially, there is an underlying theme here of stigma or "invisibility"
tied to the loss.
Because of the lack of social recognition, disenfranchised grief is a hidden
grief and this "hiddenness" can paradoxically increase the reaction
to loss. There can be an intensify emotional reactions. It can intensify
feelings of anger, guilt and/or powerlessness, thus resulting in a more
complicated grief response. Rituals may be absent or the grievers may be
excluded from rituals. The reduced or absent social support promotes a
sense of generalized isolation on the part of the griever.
Similarly, Hocker (1990) described this form of grief, referring to it
as unsanctioned and unrecognized grief and identifying the following characteristics:
- Social stigma
- embarrassment on the part of the bereaved because loss is unsanctioned
- Absence of mourning rituals
- these provide a means to express cultural beliefs and values
- communal celebration, recognition
- funeral rituals are one of these
- Grief not expressed at the proper time
- emotions are restrained, stifled and frustrated
- grief is delayed because of hostile reactions to its expression
- Economic and legal problems
- financial pressures resulting from loss that is not a legal one (e.g.,
- Emotional problems
- the disenfranchised nature of the loss can lead to emotions being exaggerated
Disenfranchised grief may lay hidden for years, only to be triggered by
later losses. Seeland (1990) proposed that this hidden grief can lead to
incomplete resolution of the tasks Worden outlined (and which we covered
in Unit 1). There may be delayed grief reactions where new grief
may build on or trigger old, unresolved grief responses. This may result
in chronic grief reaction where grief is never resolved, life becomes stagnant,
and new emotional growth cannot take place. Grief reactions may be masked,
and grief may express itself in a variety of physical, psychological, or
I would like to present a quick overview of two intervention strategies.
With regard to boundary ambiguity, Boss proposed that the following therapeutic
strategies be used:
- Label the ambiguity as a major stressor for family members (for recognition
of their situation).
- Provide a setting and structure for family meetings (so they can build
meaning together and reduce intrafamilial ambiguity).
- Provide as much information as possible about their situation (to reduce
- Provide families with sources and choices of support for their situation
(to increase the likelihood of social confirmation of their situation).
- Perhaps most important, families must be encouraged and provided a
format within which they can work to find some meaning in their loss.
These strategies are intended to facilitate the completion of the three
tasks of family grief, laid out for you in Unit 2.
In his discussion of unresolved and unsanctioned grief, Hocker recommended
- Recognize that the grief is unsanctioned and that it is, in fact, a
- Listen -- allow them to give voice to their loss.
- Understand (i.e., be understanding of their loss).
- Facilitate their resolution of the loss and work with them as they
- Take personal inventory of yourself (the interventionist), to recognize
your own grief.
Ambiguity and disenfranchisement often are experienced as essential components
of our grief process, components that complicate the grief process for
the bereaved. The ambiguity of a loss may lead to uncertainty among the
members of one's social network as to how they should respond, or even
if they should respond. It may even be possible that the loss will not
be seen to exist. Friends and relatives may feel that the best response
is no response.
At the same time, bereaved individuals need to have their loss and grief
socially legitimized by others. When it is not, their grief may be hidden
and its course extended. They may develop a type of chronic grief that
repeats itself, possibly with greater intensity, with each new loss.
Intervention in these situations emphasize recognizing and legitimizing
the loss (or losses, as in the case of multiple losses) and the grief.
Building a sense of community within the family also facilitates the completion
of family tasks centered on recognition, reorganization and reinvestment.
Questions for Discussion
Post your response to the following questions on the Class Discussion..
- What do the terms "ambiguity" and "disenfranchised"
mean to you? How do you view them in terms of loss and grief? If you had
to paint a picture of each of these, what would that picture look like? Both of these factors have been seen to contribute to a more complicated grief experience. Why do you think this is?
- How does differential grief of family members tie in with ambiguity? If you were to intervene in a family, how would you integrate the different responses among family members?
- Keeping Ruth Van Reken's writings in mind, what are the effects of a "pile-up" of unresolved ambiguous losses? What can be done to help children deal with losses that are either invisible to or hidden from others?
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