Ambiguous grief: Mourning someone who’s still alive

Grief is never just one thing. And there’s a type of grief that doesn’t get talked about enough. Ambiguous grief is the sadness you experience with the end of a friendship or a lasting rift with a family member. It can also happen if you lose the companionship of someone you love because they’re ill or incapacitated. Ambiguous grief can be just as difficult to handle as grieving over a death. Here is what you need to know to begin to navigate your way through it.

What is ambiguous grief?

Ambiguous grief is a feeling of loss for somebody who is still living, or for something significant that is gone. Ken Druck, PhD, a leading authority on healing after loss and author of The Real Rules of Life, refers to these kinds of losses as “living losses.” What makes them especially challenging is the intensity and duration of the grief. You feel as though the future as you anticipated it has changed forever, and you are heartsick.

You may well have experienced a loss like this yourself: It could involve the breakdown of a relationship with a family member or loved one whom you’ve lost to addiction or to an illness, disability or accident, says Michael S. Tobin, PhD. He’s a clinical psychologist in Jerusalem whose wife, Deborah, has Alzheimer’s disease. His experience prompted him to write the book Riding the Edge: A Love Song to Deborah.

It can also occur when you lose something that established normalcy in your life — such as when you get a divorce or lose your job. It can even happen from living through a pandemic. Or it can be something harder to pinpoint but still very real, such as the grief you feel when your own health is declining or you’re getting older. You’re mourning the loss of your youth. “In all of these cases, you may be suffering a deep sense of loss and a persisting sense of despair,” Druck says.

If feelings of loss are interfering with your daily life, speaking with a therapist can help. Licensed mental health professionals from our network are ready to listen. Start your free assessment.

Because there’s no final goodbye, as there often is when someone you love dies, ambiguous grief can be ongoing. That’s especially true if you’re dealing with the psychological, rather than physical, loss of a person.

That is what Tobin has been experiencing with his wife, who’s increasingly lost to him due to her illness. In a situation like this, you don’t experience one traumatic death, but rather many mini deaths, which can make the grieving process feel endless.

Tobin compares it with the classic “5 stages of grief” you often hear about. Popularized by Elisabeth Kübler-Ross, the theory is that when you lose someone, you go through periods of grief: denial, anger, bargaining, depression and finally acceptance. Not all experts agree that this process is so well delineated. But what does seem certain is that with an ambiguous loss, you don’t progress through the stages of grief. Instead, you can get trapped in the loss.

“I have found that the stages of grief are applicable, but with a caveat,” Tobin says. “With ambiguous loss, as with Alzheimer’s, you re-cycle through the stages as you experience multiple losses resulting from this neurodegenerative disease.” (Some people also experience anticipatory grief before an impending death. Learn more about that experience here.)

How to handle ambiguous grief

The truism that “time heals” doesn’t usually apply with ambiguous grief, since there’s no definitive ending. Your ex-husband is still your ex-husband two years down the road. A chronically ill relative may stay that way for many years.

“Every grief has a life and timetable all its own," says Druck. "We may feel like we should just ‘get over it,’ but the sadness is not going away.” So how do you cope?

Recognize that the feelings are real
Because no one has died, you (or people around you) might be tempted to downplay what you’re feeling. You might be ashamed to admit that your emotions are so strong. But the sorrow of ambiguous grief is very real, and it’s not something you should try to ignore or shove aside.

“Acknowledge that whatever you have lost is real and undeniable — and it is hitting you very hard,” Druck advises. “Give yourself permission to go through this loss. You are only human.” 

Show yourself compassion and kindness
“I tell my self-critical clients, ‘Take your foot off your throat and put your hand on your heart,’” Druck says. In other words, focus on self-care, not self-blame. When you’re feeling overwhelmed by emotions, you might go for a walk in nature or talk to a good friend. You can also give yourself permission to cry, or release your sorrow by writing in your journal, he says.

You should also surround yourself with individuals who let you vent without judging you or offering quick-fix solutions, he says. Isolating, hiding, denying and/or repressing your grief all make it harder to process the loss and can keep you from healing.

Understand that grief isn’t linear
It’s absolutely normal to have periods when your grief lifts and then settles back in again, Tobin says. Realize that you don’t need to feel guilty when you have days where you laugh and feel joy. On the other hand, he adds, don’t despair and worry that something’s wrong with you if you were hoping you had seen the worst of it and then you return to a period of deep mourning.

Reengage with the world as soon as you can
Though cycles are to be expected, try not to get stuck in your grief, Tobin says. You can be an active participant in your own healing process. Make efforts to socialize with people who make you smile and feel good about life. Switch up your environment to give yourself a break from the scene of your grief — the house where you lived with your now-ex spouse, or the hospital where a loved one is undergoing treatment.

Fresh air and movement are always good, Tobin adds. Sure, a vacation would be wonderful, but even a walk in the park can help you let go for a little while.

But don’t ignore warning signs
If, however, you continue to have persisting sorrow, bouts of anger, depression or mood swings, you may need more support. Seek help from a therapist or counselor who has experience with treating grief, Druck says.

“A professional can help you understand your feelings, reactions and expectations,” Tobin says. “Hopefully, by seeing how you’re stuck, you can move on and accept the situation.”

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Additional sources
Traumatic grief: University of Utah (2019). "Traumatic Grief: Looking Through a Wider Lens"
Stages of Grief: University of Washington (2020). "The Stages of Grief: Accepting the Unacceptable"; University of Colorado, Boulder (n.d.). "Four Phases of Grief: Grieving the Loss of a Loved One"
Grief and Covid-19: American Psychological Association (2020). "Covid-19 Special Report, Grieving Life and Loss"