AMBIGUOUS LOSS Prepared by Linda S. Golding MA, BCC A Spiritual Assessment Tool 1.0 Prepared by Linda S. Golding MA, BCC NewYork-Presbyterian Hospital Prepared by Linda Golding MA, BCC, New York-Presbyterian Hospital. Linda S Golding, MA, BCC Patricia Punzalan, MA, RN, NE-BC New York Presbyterian Hospital, New York

“With ambiguous loss, there is no closure; the challenge is to learn to live with the ambiguity.” --Pauline Boss, PhD Literature (odyssey, opera, divine comedy, the binding of isaac, the raising of lazarus)

How many of you work in hospitals – hospices – nursing homes?

Ambiguous

Ambiguous: doubtful, uncertain; open to multiple interpretations.

Loss

diminution of power or control. Loss: deprivation; decrease in; diminution of power or control. .

Ambiguous Loss Can be caused by random, uncontrollable external forces and can be responded to by internal coping processes. Resilience is key to coping

Ambiguous Loss Can be caused by random, uncontrollable external forces and can be responded to by internal coping processes. It is a loss that is unclear, without closure. It is considered a relational and systemic rather than individual loss.

How does it differ from ordinary loss? Ambiguous Loss How does it differ from ordinary loss?

Ambiguous Loss There is no verification of death. No certainty that the person will return. The person may not be as he/she used to be. Think of people who insist on going to the morgue to SEE the dead person.

Why does it matter?

Ambiguous loss freezes the grief process Ambiguous loss freezes the grief process. Paralyzes individual and system functioning.

Types of Losses Everyday Losses Catastrophic Losses

Types of Ambiguous Losses   Physically absent and psychologically present. Physically present and psychologically absent.

Physically Present

Psychologically Absent Addiction, Alzheimer’s, dementia, comatose state, brain injury, autism, depression, chronic mental or physical illnesses that take mind or memory away. Survivors of domestic abuse, genocide, slavery, holocaust, homelessness, poverty.

Identifying Ambiguous Loss What might the individual and the system be experiencing?

Identifying Ambiguous Loss Loss of how the person used to be. Loss of relationships. Loss of identities, sense of self in relation. Shifting roles and hopes. Altered socio-economic status, etc.

Identifying Ambiguous Loss Emotionally?

Identifying Ambiguous Loss Exhaustion Confused decision making Trouble coping Immovable grief or sadness Depression Conflict, behavioral issues Substance abuse, etc.

Grieving Ambiguous Loss Until death is confirmed: Open ended duration of grieving and mourning. Trying to learn both/and thinking.  

Grieving Ambiguous Loss Once actual death is confirmed: Depending on the mourning work leading up to this time -- Feelings of relief Guilt Resentment

Grieving Ambiguous Loss While it is in the holding pattern? Inexplicable sorrow Anger Guilt Resentment General uncertainty Risky behavior

Spiritual Assessment Model Looking for resilience: Finding Meaning Adjusting Mastery Reconstructing Identity Normalizing Ambivalence Revising Attachment Discovering Hope

Spiritual Assessment Model Finding Meaning

Spiritual Assessment Model Finding Meaning Adjusting Mastery

Spiritual Assessment Model Finding Meaning Adjusting Mastery Reconstructing Identity

Spiritual Assessment Model Finding Meaning Adjusting Mastery Reconstructing Identity Normalizing Ambivalence

Spiritual Assessment Model Finding Meaning Adjusting Mastery Reconstructing Identity Normalizing Ambivalence Revising Attachment

Spiritual Assessment Model Finding Meaning Adjusting Mastery Reconstructing Identity Normalizing Ambivalence Revising Attachment Discovering Hope

CASE STUDY Charlie is 25 years old and was diagnosed with Cystic Fibrosis as a baby. He was a stoic boy and is a stoic young man despite the regular bouts of severe illness. He completed college with a degree in the creative arts, lives on his own and is an avid runner, boxer and martial artist. Charlie and his parents lived as though each day was one of Charlie’s last.  Four weeks ago, Charlie was admitted to the hospital and his parents understood this could be his final hospitalization. Instead, Charlie received a double lung transplant. While recovering from the surgery and stabilizing with the transplant and all its attending medications and complications, Charlie found himself at the lowest emotional and spiritual point in his life: he was not sure it was worth the effort to live, he was without hope that the medical issues would turn around despite the team’s reassurance, he did not understand why he could not find God in this very dark place. His parents were mystified by Charlie’s despondence and by what they called “his whining.” Why now, when life is more assured?

Charlie Finding Meaning Adjusting Mastery Reconstructing Identity Normalizing Ambivalence Revising Attachment Discovering Hope

Charlie’s Parents Finding Meaning Adjusting Mastery Reconstructing Identity Normalizing Ambivalence Revising Attachment Discovering Hope

And what about the resilience for…

The Care Providers Finding Meaning Adjusting Mastery Reconstructing Identity Normalizing Ambivalence Revising Attachment Discovering Hope

Questions?

Thank You