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Families of the missing: Psychosocial effects and therapeutic approaches

Published online by Cambridge University Press:  05 July 2018

Abstract

Families of the missing often have no facts to clarify whether their loved one is alive or dead, or if dead, where the remains are located. Such loss is called “ambiguous loss”, and those suffering from it will usually resist change and will continue to hope that the missing person will return. As this article will endeavour to explain, our goal as professionals working with the families of the missing is to help them shift to another way of thinking that allows them to live well despite ambiguous loss. To do this, we must acknowledge that the source of suffering – the ambiguity – lies outside the family. The article offers a psychosocial model with six guidelines focusing on meaning, mastery, identity, ambivalence, attachment, and finding new hope.

Type
The missing and their families
Copyright
Copyright © icrc 2018 

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References

1 Boss, Pauline, Loss, Trauma, and Resilience: Therapeutic Work with Ambiguous Loss, W. W. Norton, New York, 2006Google Scholar; Boss, Pauline, “The Context and Process of Theory Development: The Story of Ambiguous Loss”, Journal of Family Theory & Review, Vol. 8, No. 3, 2016CrossRefGoogle Scholar; Boss, Pauline, Beaulieu, Lorraine, Wieling, Elizabeth, Turner, William and LaCruz, Shulaika, “Healing Loss, Ambiguity, and Trauma: A Community-Based Intervention with Families of Union Workers Missing after the 9/11 Attack in New York City”, Journal of Marital & Family Therapy, Vol. 29, No. 4, 2003CrossRefGoogle ScholarPubMed; Hollander, Theo, “Ambiguous Loss and Complicated Grief: Understanding the Grief of Parents of the Disappeared in Northern Uganda”, Journal of Family Theory & Review, Vol. 8, No. 3, 2016CrossRefGoogle Scholar; Robins, Simon, “Ambiguous Loss in a Non-Western Context: Families of the Disappeared in Postconflict Nepal”, Family Relations, Vol. 59, No. 3, 2010CrossRefGoogle Scholar; Robins, Simon, Families of the Missing: A Test for Contemporary Approaches to Transitional Justice, Routledge Glasshouse, New York and London, 2013Google Scholar; Robins, Simon, “Constructing Meaning from Disappearance: Local Memorialisation of the Missing in Nepal”, International Journal of Conflict and Violence, Vol. 8, No. 1, 2014Google Scholar; Robins, Simon, “Discursive Approaches to Ambiguous Loss: Theorizing Community-Based Therapy After Enforced Disappearance”, Journal of Family Theory & Review, Vol. 8, No. 3, 2016CrossRefGoogle Scholar.

2 S. Robins, “Discursive Approaches to Ambiguous Loss”, above note 1, p. 322.

3 P. Boss, Loss, Trauma and Resilience, above note 1; P. Boss et al., “Healing Loss, Ambiguity, and Trauma”, above note 1; Boss, Pauline and Ishii, Chikako, “Trauma and Ambiguous Loss: The Lingering Presence of the Physically Absent”, in Cherry, Katie E. (ed.), Traumatic Stress and Long-Term Recovery: Coping with Disasters and Other Negative Life Events, Springer, New York, 2015Google Scholar; Landau, Judith and Saul, Jack, “Facilitating Family and Community Resilience in Response to Major Disaster”, in Walsh, Froma and McGoldrick, Monica (eds), Living Beyond Loss, 2nd ed., W. W. Norton, New York, 2004Google Scholar; T. Hollander, above note 1; S. Robins, “Ambiguous Loss in a Non-Western Context”, above note 1; S. Robins, Families of the Missing, above note 1; S. Robins, “Discursive Approaches to Ambiguous Loss”, above note 1.

4 S. Robins, “Discursive Approaches to Ambiguous Loss”, above note 1.

5 While DNA evidence may eventually help to clarify ambiguous losses, many families remain without such verification. For example, since the September 11 attack on New York's World Trade Centre in 2001, almost half of the missing are still missing. There is no DNA evidence as yet for their families. This is the case, even with improved technology, for many families of the missing. For this reason, the author's focus continues to be on increasing the resilience of the families of the still missing, for they may never know the fate of their loved ones.

6 P. Boss, Loss, Trauma and Resilience, above note 1; P. Boss, “The Context and Process of Theory Development”, above note 1; P. Boss et al., “Healing Loss, Ambiguity, and Trauma”, above note 1; T. Hollander, above note 1; S. Robins, Families of the Missing, above note 1; S. Robins, “Discursive Approaches to Ambiguous Loss”, above note 1.

7 Boss, Pauline, Ambiguous Loss: Learning to Live with Unresolved Grief, Harvard University Press, Cambridge, MA, 1999Google Scholar; P. Boss, Loss, Trauma and Resilience, above note 1; P. Boss, “The Context and Process of Theory Development”, above note 1.

8 The theoretical work about ambiguous loss grew out of the author's original interest in family stress. See Boss, Pauline, “Family Stress: Perception and Context”, in Sussman, Marvin and Steinmetz, Suzanne (eds), Handbook of Marriage and the Family, Plenum, New York, 1987Google Scholar; Boss, Pauline, Family Stress Management, 2nd ed., Sage, Thousand Oaks, CA, 2002Google Scholar; Boss, Pauline, “Family Stress”, in Michalos, Alex C. (ed.), Encyclopedia of Quality of Life and Well-Being Research, Springer, Dordrecht, 2014, pp. 22022208CrossRefGoogle Scholar; Boss, Pauline, Bryant, Chalandra and Mancini, Jay, Family Stress Management, 3rd ed., Sage, Thousand Oaks, CA, 2016Google Scholar.

9 For more information on psychological ambiguous loss, see P. Boss, Loss, Trauma and Resilience, above note 1; Boss, Pauline, Loving Someone Who Has Dementia: How to Find Hope while Coping with Stress and Grief, Jossey-Bass, San Francisco, CA, 2011Google Scholar.

10 Also see Pauline Boss, Ambiguous Loss, above note 7; Boss, Pauline, “Ambiguous Loss Research, Theory, and Practice: Reflections after 9/11”, Journal of Marriage & Family, Vol. 66, No. 3, 2004CrossRefGoogle Scholar; P. Boss, Loss, Trauma and Resilience, above note 1; P. Boss, “The Context and Process of Theory Development”, above note 1; P. Boss, C. Bryant and J. Mancini, above note 8.

11 P. Boss et al., “Healing Loss, Ambiguity, and Trauma”, above note 1.

12 Doka, Kenneth J., Disenfranchised Grief: Recognizing Hidden Sorrow, Lexington Press, Lexington, MA, 1989Google Scholar.

13 Shear, M. Katherine, Simon, Naomi, Wall, Melanie et al. , “Complicated Grief and Related Bereavement Issues for DSM-5”, Depression and Anxiety, Vol. 28, No. 2, 2011CrossRefGoogle ScholarPubMed.

14 P. Boss, Ambiguous Loss, above note 7; Pauline Boss, “Reflections after 9/11”, above note 10; P. Boss, Loss, Trauma and Resilience, above note 1.

15 Merton, Robert K. and Barber, Elinor, “Sociological Ambivalence”, in Tiryakian, Edward (ed.), Sociological Theory: Values and Sociocultural Change, Free Press, New York, 1963Google Scholar.

16 P. Boss, Ambiguous Loss, above note 7; P. Boss, “Reflections after 9/11”, above note 10; P. Boss, Loss, Trauma and Resilience, above note 1; P. Boss, “The Context and Process of Theory Development”, above note 1; T. Hollander, above note 1, S. Robins, “Constructing Meaning from Disappearance”, above note 1; S. Robins, “Discursive Approaches to Ambiguous Loss”, above note 1.

17 P. Boss, Ambiguous Loss, above note 7; P. Boss, C. Bryant and J. Mancini, above note 8; P. Boss, “Reflections after 9/11”, above note 10.

18 Boss, P., “The Trauma and Complicated Grief of Ambiguous Loss”, Pastoral Psychology, Vol. 59, No. 2, 2010CrossRefGoogle Scholar; T. Hollander, above note 1.

19 P. Boss, Ambiguous Loss, above note 7; P. Boss, Loss, Trauma and Resilience, above note 1; P. Boss, C. Bryant and J. Mancini, above note 8.

20 Boss, P., “Ambiguous Loss: Working with Families of the Missing”, Family Process, Vol. 41, 2002CrossRefGoogle ScholarPubMed; P. Boss, Loss, Trauma and Resilience, above note 1.

21 P. Boss, Ambiguous Loss, above note 7; P. Boss, Loss, Trauma and Resilience, above note 1.

22 Boss, Pauline, Roos, Susan and Harris, Darcy L., “Grief in the Midst of Uncertainty and Ambiguity”, in Neimeyer, Robert A., Harris, Darcy L., Winokuer, Howard R. and Thornton, Gordon F. (eds), Grief and Bereavement in Contemporary Society: Bridging Research and Practice, Taylor and Francis, New York, 2011Google Scholar.

23 For details, see P. Boss, Loss, Trauma and Resilience, above note 1; P. Boss, C. Bryant and J. Mancini, above note 8; T. Hollander, above note 1.

24 For more on boundary ambiguity, see Boss, Pauline, “Ambiguous Loss Theory: Challenges for Scholars and Practitioners”, Family Relations, Vol. 56, No. 2, 2007CrossRefGoogle Scholar; P. Boss et al., “Healing Loss, Ambiguity, and Trauma”, above note 1.

25 P. Boss, Loss, Trauma and Resilience, above note 1.

26 White, Michael and Epston, David, Narrative Means to Therapeutic Ends, W. W. Norton, New York, 1990Google Scholar.

27 Author's note: My granddaughter, who studies physics at Stanford University, told me that such “both-and” thinking reminds her of the thought experiment known as Schrödinger's cat. Hypothetically, the idea is that a cat is placed in a closed box containing a lethal substance that may or may not activate. Until the lid is opened, therefore, no one knows if the cat is alive or dead; that is to say, until observers can see the cat, it is simultaneously, for that time, both alive and dead (see Gribbin, John, In Search of Schrödinger's Cat: Quantum Physics and Reality, Bantam, Toronto, 1984Google Scholar). My granddaughter was right that a similar paradox exists between the simultaneous possibilities of both life and death. But aside from the actual reality of ambiguous loss versus this thought experiment, there is a major difference here: for families of the missing, the “box” often stays closed forever. The ambiguity continues, and the answer is never revealed. See P. Boss, “The Context and Process of Theory Development”, above note 1, p. 273.

28 For in-depth discussions, see P. Boss, “Reflections after 9/11”, above note 10; P. Boss, Loss, Trauma and Resilience, above note 1; P. Boss, “The Context and Process of Theory Development”, above note 1; P. Boss et al., “Healing Loss, Ambiguity, and Trauma”, above note 1.

29 For a full discussion, see P. Boss, Ambiguous Loss, above note 7; P. Boss, Loss, Trauma and Resilience, above note 1; P. Boss, “The Context and Process of Theory Development”, above note 1, pp. 272–273.

30 P. Boss, Ambiguous Loss, above note 7; P. Boss, Loss, Trauma and Resilience, above note 1.

31 National Police Agency of Japan, “Damage Situation and Police Countermeasures Associated with 2011 Tohuko District”, available at: www.npa.go.jp/news/other/earthquake2011/pdf/higaijokyo_e.pdf (accessed in May 2018). As of 9 March 2018, over seven years after the devastating Japanese earthquake and tsunami, the National Police Agency of Japan has confirmed a total of 15,895 deaths, 6,156 injured and 2,539 missing.

32 P. Boss and C. Ishii, above note 3.

33 P. Boss, Loss, Trauma and Resilience, above note 1.

34 Forman, Maurice Buxton (ed.), The Letters of John Keats, 2nd ed., Oxford University Press, New York, 1935, p. 72Google Scholar.

35 P. Boss, Loss, Trauma and Resilience, above note 1.

36 P. Boss, Ambiguous Loss, above note 7; P. Boss, “Reflections after 9/11”, above note 10; P. Boss, Loss, Trauma and Resilience, above note 1; P. Boss, Loving Someone Who Has Dementia, above note 9.

37 The present author formulated the original guidelines for family meetings based on psychological ambiguous loss in families with a loved one who had Alzheimer's disease (P. Boss, Ambiguous Loss, above note 7, pp. 109–132). In 2001, she adapted these family meeting guidelines after 9/11 for the situation of physical ambiguous loss.

38 P. Boss, Loss, Trauma and Resilience, above note 1.

39 Masten, Ann, “Ordinary Magic: Resilience Processes in Development”, American Psychologist, Vol. 56, 2001CrossRefGoogle ScholarPubMed; Masten, Ann, “Resilience in the Context of Ambiguous Loss: A Commentary”, Journal of Family Theory & Review, Vol. 8, No. 3, 2016CrossRefGoogle Scholar.

40 The following guidelines are based on four decades of work with families of the missing (see www.ambiguousloss.com) and adapted from P. Boss, Ambiguous Loss, above note 7; P. Boss, Loss, Trauma and Resilience, above note 1; P. Boss et al., “Healing Loss, Ambiguity, and Trauma”, above note 1; P. Boss and C. Ishii, above note 3; Boss, Pauline and Dahl, Carla M., “Family Therapy for the Unresolved Grief of Ambiguous Loss”, in Kissane, David W. and Parnes, Francine (eds), Bereavement Care for Families, Routledge, New York, 2014Google Scholar.

41 P. Boss, Loss, Trauma and Resilience, above note 1.

42 Frankl, Viktor, Man's Search for Meaning, Beacon Press, Boston, MA, 1963Google Scholar; see also P. Boss, C. Bryant and J. Mancini, above note 8.

43 P. Boss, Loss, Trauma and Resilience, above note 1.

44 Boss, P., Verlust, Trauma und Resilienz, Klett-Cotta, Stuttgart, Germany, 2008Google Scholar

45 Boss, P., Aimaina soshitsu to torauma karano kaifuku: Kazoku to komyuniti no rejiriensu (Recovering From Ambiguous Loss and Trauma: Resilience of Family and Community), Seishin Shobo, Tokyo, 2015Google Scholar.

46 ICRC, Tbilisi, forthcoming.

47 See P. Boss, Loss, Trauma and Resilience, above note 1, Ch. 4.

48 S. Robins, “Ambiguous Loss in a Non-Western Context”, above note 1.

49 Ibid.; S. Robins, Families of the Missing, above note 1.

Ibid

50 See P. Boss, Loss, Trauma and Resilience, above note 1, Ch. 6.

51 See Merton and Barber discussion at above note 15.

52 Bowlby, John, Loss: Sadness and Depression, Vol. 3, Attachment and Loss Series, Basic Books, New York, 1980Google Scholar.

53 See P. Boss, Loss, Trauma and Resilience, above note 1, Ch. 7.

54 Ibid., Ch. 8.

Ibid

55 See ibid. for more details.

ibid

56 For more information on the self of the therapist, see ibid., pp. 197–210.

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