Alzheimer's Foundation of America

Foundation of America

Ambiguous Loss: Put Your Own Mask On First

By Laurel Gumpert, MPH, MBA

When you’re on a plane, before take-off, the flight attendants will go through typical safety protocols, including, “If oxygen masks are needed, put your mask on first before helping others with theirs.” There’s a practical reason for this—if you can’t breathe, it’s impossible for you to help someone else.

The oxygen mask analogy relates closely to caregivers. Many times, they’ll try to help their loved ones without regard to themselves, but that is not safe or sustainable. Making yourself a priority is imperative, especially with ambiguous loss.

What is Ambiguous Loss?

Family therapist Dr. Pauline Boss created the term in the 1970s while speaking to families of soldiers who went missing in action. According to Dr. Boss, ambiguous loss is a loss that occurs without closure or a clear understanding—part of a person is with us and part of them is not. Examples of ambiguous loss that can leave family members searching for answers include infertility, disappearance of a family member, death of an estranged family member, even what we have all experienced over the past two-plus years with the COVID-19 pandemic.

A common form of ambiguous loss is when a family member is physically alive, but cognitively changed due to Alzheimer’s disease or another related dementia. This phenomenon is incredibly common, even though it is not widely spoken about. If you think about the last couple of years, we’ve all experienced some form of ambiguous loss—loss of a job, time, or sense of safety and security.

You may experience ambiguous loss from a breakup or a move across the country. Maybe you’ve lost trust in people, or lost hope in a future. And if you are caring for someone with Alzheimer’s disease, you may be experiencing ambiguous loss.

Ambiguous loss is a difficult feeling, as it relates quite closely to anticipatory grief. Anticipatory grief occurs before physical death, but upon realizing that your loved one may die soon. We see anticipatory grief among families of those with a fatal illness or when a loved one is living with Alzheimer’s disease or another related dementia.

The family members know their loved one will decline and then pass away. It is anticipatory for this reason due to the knowledge that their loved one’s mental state will continue to change. They begin to grieve early. Understandably, these situations are difficult and potentially damaging for family members and caregivers. Stress, exhaustion, confusion, depression, anxiety, substance misuse, and PTSD are some of the physical and mental affects that ambiguous loss can cause. Finding ways to cope with ambiguous loss is vital.

Here are some ideas to cope with ambiguous loss and anticipatory grief:

Call it what it is.

Speaking about problems out loud and naming them can actually help make them a little less scary. Understanding that this is ambiguous loss and is different from traditional loss can give a person permission to grieve in their own individual way.

Practice “both/and” thinking.

Society often thinks or acts in absolutes. Someone can either feel happy or sad, not both. Human beings do not operate in absolutes, so becoming used to “both/and” thinking is incredibly valuable. This gives permission to the person with ambiguous loss to settle with their current reality and not search for some perfect solution. Someone could feel both sad that their loved one is sick, and happy that they have a new grandchild. Or someone may both wish that the illness their loved one is going through is over and wish they could keep on living. Learn to accept “both/and” thinking and understand that it’s okay to feel all the emotions.

Do not seek closure.

Dr. Pauline Boss states that we should not seek closure in ambiguous loss. In losses such as these, closure does not exist. Rather than seeking closure, we should find new ways to cope. We should look for individualized ways to continue to move forward in the face of ambiguous loss.

Find something new to hope for.

Hope is a powerful thing. Despite what someone may be going through with a difficult loss, find something that’s hopeful and uplifting. Whether that is a nice vacation or just a trip to your local coffee shop every Saturday, having something to look forward to can really make a difference.

Take care yourself.

Make sure you are taking care of yourself in every way—mentally, physically, emotionally, and spiritually. And remember what the flight attendants always say: Put the oxygen mask on yourself first.

Have additional questions about ambiguous loss or need to speak with someone? Contact AFA’s Helpline social workers seven days a week by phone (866-232-8484), webchat (, or text message (646-586-5283).

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