Rena Perlmutter

Ambiguous Loss

Death and mourning are a part of life. Most people will experience the loss of
a loved one. When death occurs, there is a protocol that follows the death; a
funeral, eulogies, and then a week of mourning. People come to the house to
comfort those who are mourning. This allows the person to speak about the
loss of the person and receive comfort from his extended family and friends.
The death is acknowledged by the family, friends and the community, allowing
closure and the ability to heal.

In the 1970s, researcher Dr. Pauline Boss, PhD, came up with the term
“ambiguous loss” to describe grief that has no definitive boundary or closure.
Dr. Boss identified two types of ambiguous loss.

The first is when a person is alive and there is no contact. For example, a
soldier who has gone missing , or a parent who is estranged from a child, are
some of the forms of this type of ambiguous loss.

The second type is when the person is physically present and part of one’s life
but is emotionally absent. An example is when a person is suffering from
Alzheimers, he is physically alive but is unable to be emotionally available, or
when a loved one has succumbed to addiction or mental health illness. The
common denominator is the loss of a relationship that is no longer present.
When a child is diagnosed with a mental illness, a parent needs to allow
himself the space to mourn his child. While the child is in the clutches of the
disease of self harming, he is no longer emotionally available . The disease
has taken away the child you once knew. A parent is allowed to
acknowledge, become angry, and cry for the loss.

In addition, raising a child who has mental challenges is filled with ambiguity
and confusion. On some level the role of the parent needs to be revisited.
For some parents it means that their child will not be able to live an
independent life. Parents need to explore the option of placing an adult child
into an assisted living project. For others, it means learning to let go and
allowing the child to learn from his mistakes and suffer the consequences.
Jamie Canon states three things to expect when mourning a person who is
still living.

1) Life somehow changes while staying exactly the same. A parent
logically knows that the emotional attachment is no longer alive with a
child who is suffering from addiction/cutting or any mental diagnosis.
The heart to heart conversations, or even watching a funny movie, are
at times not possible. It is natural for a parent to mourn and yearn for
the relationship to return. Life becomes focused on the next crisis.
Oftentimes, when a parent is dealing with a child who is suffering from
mental illness, he will find himself looking at his child and not knowing
where their child’s inner being went. Life as you once knew with your
child might never be the same and that is emotionally terrifying.

2) A parent will suddenly be thrust into unfamiliar roles. One must find the
right psychiatrist and programs to help his child, and make sure his child
is safe. Learning to live with a new reality, while continuing to be
present for other family members and outside responsibilities, becomes
a challenge.

3) Parents of the mentally ill child are constantly bombarded by reality
when trying to hold onto hope. The journey to recovery is not simple.
One needs to expect setbacks. Do not define a setback as a failure, but
as part of the healing process. It is so easy to burn out. Endless
appointments with professionals and learning about the diagnosis takes
a toll on the parents. Parents learn to live in survival mode while trying
to put the pieces of information together. Never give up on the hope of
life returning to normal. There is recovery from self harming. Most
mental health issues can be helped with proper medication and

Those experiencing Ambiguous Death need to go through the Kubler-Ross
Five Stages of Mourning in order to heal.

Denial that there is a problem. The first step in recovery is realizing that there
is a problem. Telling yourself it is a faze and he will grow out of it, is denial.
Telling yourself he is alive so therefore I do not need to worry, is denial. Denial
does not get your child the help he needs. It just allows the parent to avoid
confronting the problem. As Einstein said “Insanity is doing the same thing
over and over and expecting different results”. Denial perpetuates insanity.
Anger comes once a parent realizes that there is a problem. He is no longer
in denial. Cry, write in a journal, exercise, or listen to music. Let the anger
out, not at your child or anyone in the family. Letting out anger on family
members will only cause more trouble.

Bargaining is when you feel so hopeless that you are willing to do anything to
restore yourself and your child to sanity. Usually a parent will bargain with
God, declaring he will be a better parent, to take upon acts of kindness in the
hope that it will help his child.

Depression is associated with grief. It can be a reaction to the emptiness we
feel when we are living in reality and realize the person or situation is gone or
over. When raising a child with mental challenges, parents might withdraw
and isolate. Feeling as if no one will understand, or others have a perfect life,
are common feelings that can lead to depression. Sleepless nights are
common for those who have to keep a watch on their child. Parents often say
that they can’t sleep because they are so filled with worry and fear. Many
parents have needed to spend a few days in bed, because the pain was so
great it drained them of all their energy. This is normal as long as it does not
continue and turn into clinical depression.

Acceptance The last stage of grief identified by Kübler-Ross as acceptance.
Parents begin to accept the new reality. This allows them to stabilize their
emotions and begin to re-enter the world. It is definitely a time of adjustment
and readjustment. There are good days, there are bad days, and then there
are good days again. In this stage, it does not mean you’ll never have another
bad day, where you are uncontrollably sad. But, the good days tend to
outnumber the bad days. In this stage, you may lift from your fog, start to
engage with friends again, and might even make new relationships as time
goes on. You understand your child is suffering. The suffering is not about
you as a parent. Now you can see your child through the lenses of love and
compassion. Now parents can move forward , grow, and evolve into their new

People who are grieving a loss go in and out of these stages of grief in no
particular order. When one is experiencing an ambiguous loss, one might
become stuck in any one of the stages. This is referred to as frozen grief.
Dr. Perwith says ambiguous mourning is an ongoing trauma, because there is
no clear time frame. When dealing with mental health there are no clear
answers. At times there are setbacks, or readjustment of medication that can
trigger the trauma . Parents should find a support group and seek counseling.
Looking for the small good things is always helpful. Make a nightly gratitude
list to help you focus on the good in life.

Rena Perlmutter, Parent Coach
Please feel free to reach out to me at

About the Author
Rena Perlmutter is a mother of 5. Originally from California, she has lived in Beit Shemesh for 25 years. With a Bsc in Education, a Ministry of Education Parenting Coach certification, Rena combines DBT and twelve steps in her practice. Rena specializes in coaching parents of teens who are struggling with mental health issues and substance use disorders.