unsolved

03.15.14

The Flight 370 Paradox: How Do You Mourn a Missing Person?

It’s the worst type of grief: the uncertainty over whether a loved one is dead or somehow still alive. A talk with a leading therapist on ‘ambiguous loss.’

Seven days after Flight 370 disappeared, the families of those on board are stuck in an undertow of uncertainty. Trapped at the center of a mysterious narrative that shifts from hope to despair in seconds. 

Pauline Boss, a professor emeritus from the University of Minnesota and author Ambiguous Loss, refers to this struggle as “ambiguous loss,” a term she coined while counseling families with loved ones MIA in Vietnam in 1970s. Boss is an expert in this gray area, where an unlucky few must spend their lives. In the wake of major disasters, including Fukushima and the Indian Ocean tsunami, she has counseled psychologists on how to guide those met with this fate.

In between Skyping one such doctor in Kuala Lumpur, Boss spoke with The Daily Beast about the most recent tragedy in this domain.

What was your first reaction to the news about Flight 370?  

My first reaction was sorrow for the families of crew and passengers, because in my 30 years of working with families of missing people I know how painful that kind of loss that can be. The uncertainty and not knowing is an agony far beyond other kinds of losses that other people experience.

You have a special term for this loss—ambiguous loss.

Yes, it’s a term I coined in the 1970s when I was working with families of pilots MIA in Southeast Asia. Now the term is in the general lexicon for losses that have no facts—no information about whether the person is dead or alive, or what their fate may be. It is one of the most difficult types of losses.

What makes this particular loss so painful?

The reason it is so painful is because there is no opportunity for closure. The family has no information about what has happened. They’re left in limbo, not knowing whether or not the person is coming back. With a clear-cut loss, you have a body, you have a death certificate, you have rituals to deal with remains, and most often you have friends and family to help you get through that period of transformation from your loved one being alive to your loved one being dead. Then you can be mourning. For people who have someone missing, none of that is possible.

So what does ambiguous loss look like?

They’re stuck in what I call a frozen grief; they can’t be grieving because they feel disloyal to the missing person if they begin acting as if they’re dead. One of the worst things you can tell people with a missing loved one is that they are dead, because we don’t know.

How should psychiatrists be treating these patients in these situations?

There are three sentences that I begin with early on: What are you experiencing is ambiguous loss. It’s one of the most painful kinds of loss because there is no closure. It is not your fault. I’m quite concerned that some professionals, from reports that I’ve heard, are saying that people should be told their loved ones are dead. That doubles the trauma because it’s not true. There’s no proof yet. Later on there may be. When there is no proof of death, people take longer time to come to the conclusion that their loved one might be coming back.

Most of the individuals I work with dream a lot. They dream different scenarios about what may have happened. This creates an underlying anxiety that may be present forever.

How damaging is telling them their loved one is dead?

It’s paradoxical. The more you say: “Your loved one is dead,” the angrier they become. I support them in their anger. It’s the professionals who have trouble with ambiguity because they don’t know how to address it. We’re trained for grief. For certainty, for closure. We’re not trained to teach people how to deal with ambiguity.

How does it evolve over time?

The point is people will say things like: “My son is probably dead, but maybe not.” That paradoxical thinking is the only way to live with ambiguous loss, it’s the only way to survive. The rest of us have to live with them saying that—even 20 years later. There is absolutely no closure. We know that from the Holocaust, from stories of slavery and genocide. The situation is pathological, not the people who keep remembering.

What do you hope your patients understand from your therapy?

What we want them to do is move forward with their lives even while they think of their missing loved ones. We don’t want it to be an obsession, but what I have learned is that people are never 100 percent sure that the person is dead and not coming back. Even the tsunami—there are people there who believe their loved ones may be alive somewhere. I don’t argue with people because sometimes the missing soldier does come out of the jungle. In the absence of facts, all theories are valid.

How does the brain react to ambiguous loss?

Neuroscientists are now telling us that the brain does not like ambiguity. The brain seeks an answer. Most of the individuals I work with dream a lot. They dream different scenarios about what may have happened. This creates an underlying anxiety that may be present forever. My hope in working with them is to make sure that that anxiety is not immobilizing.

Do you think that these families will be able to find the help they need?

I worry about them being pressured to accept the loss too soon. Until there is absolute evidence about the fate of their airplane and the fate of their loved one, professionals, journalist, and media need to have patience with them. If people say there loved one is dead, they are doubly traumatizing these people. They will come to that conclusion on their own someday, it’s not for us to tell them that.