Measuring Ambiguous Loss: The Challenges of Finding a Quantitative Indicator
By Simon Robins
ICRC/CTA Missing Persons Centre
Ambiguous loss has long been used as a standard framework for understanding how individuals and families are affected by the absence of a relative. In the context of a missing person, ambiguous loss is defined as an unclear loss that has no resolution because the family lacks definitive information about the fate and whereabouts of the lost person. Ambiguous loss theory, which was developed over 30 years ago by Pauline Boss, is based on the premise that ambiguity about the absence or presence of a missing person is stressful and traumatizing for those who experience it. For individuals or families, and indeed for communities as a whole, this ambiguity freezes the grieving process, prevents cognition, blocks decision-making processes, and immobilizes people, holding them in the painful limbo of not knowing.
From qualitative to quantitative approaches
Empirical work on understanding ambiguous loss and its impacts has been largely qualitative. It seeks to understand subjective perceptions of its effects by asking people to describe them, in a process analogous to the narrative methods that define therapeutic approaches. This has led to a large number of studies analysing the psychological, emotional and social impact and manifestations of ambiguous loss in multiple contexts.
It has long been an ambition of practitioners to develop a quantitative instrument that could readily assess the extent to which an individual is suffering from ambiguous loss. Yet the quantitative approach faces significant challenges. For one thing, the impacts of ambiguous loss are rooted in the subjectivity of those experiencing it. As such, the concept of “reliability” that is integral to such a measure does not make sense when it comes to assessing a perceptual phenomenon that is expected to change over time.
Secondly, how and to what extent ambiguous loss is experienced are highly dependent upon social location, not least because ambiguous loss is a relational disorder. Some of the most extreme impacts of ambiguous loss relate to stigma and exclusion, which are a function of both the culture in which the individual finds themselves and their position within it. In patriarchal societies, for example, the greatest impacts on women whose husbands are missing arise from finding their identity challenged: because they are not wives or widows, they are not understood by their peers.
For these reasons, many have assumed that ambiguous loss – a socially constructed phenomenon that is primarily concerned with finding meaning in a situation that cannot be comprehended – is best investigated qualitatively.
ALI+: A quantitative measure of ambiguous loss
But not everyone agrees. In a recent paper called “Measure of Psychological Reactions to the Disappearance of a Loved One”, a small group of researchers sets out to develop a quantitative indicator. Their approach is built around the Ambiguous Loss Inventory Plus (ALI+), a three-part measure aimed at identifying ambiguous loss symptomatology. The first two parts, drawing on existing measures of grief and loss, are designed to assess losses that may be ambiguous and note the relationship to the missing person. They also seek to capture grief-like reactions to ambiguous loss in a process similar to those used to measure the impacts of prolonged grief disorder. The third part consists of impacts of ambiguous loss, the list of which was developed following a literature review and an expert meeting. These impacts include, for example, intrusive thoughts, feelings of stasis, family tension, and concern that rituals for the dead have not been done. This list of impacts was reviewed by small groups of both relatives of missing persons and experts to ensure comprehensibility and relevance.
The expert discussion at the end of the paper points to some of the challenges the ALI+ will face. For instance, in discussing the difference between “grief” and “separation distress”, the experts stressed the importance of using the latter because ambiguous loss prevents proper grieving. Yet, to some extent, the ALI+ is based on grief theory and grief therapy assessments rather than family stress theory.
Another challenge to the validity of ALI+ emerges from the small (n=7) and rather homogeneous (refugees in Europe) group used to develop it.
Lastly, the underlying linguistic and conceptual subtleties already alluded to in the development of ALI+ must be addressed wherever it is to be used. Indeed, many of the studies made of ambiguous loss show highly context- and culture-specific impacts, such as repeated dreams of the missing (often interpreted as visits of their spirit). These impacts are articulated in ways that are rooted in a non-Western understanding of mind-body relations, and local idioms of distress are a challenge to translate.
In view of obstacles such as these, practitioners still prefer qualitative approaches. But they recognize that ALI+ is a step forward, and they will follow its progress keenly as efforts continue to demonstrate its reliability and validity in multiple contexts.
Future research: Project Researching the Impact of Separated and Missing Family (PRISM Family)
While there is a clear need to develop better measures of ambiguous loss, it is also recognized that the psychological and social burden borne by individuals, families and communities whose loved ones are missing is multifaceted, diverse and dynamic. To address this knowledge gap, a new research project based in Australia has been launched. The Project Researching the Impact of Separated and Missing Family (PRISM Family) aims to document and map the psychological and social effects of the absence of a family member on forcibly displaced people settled in Australia. The project, funded by an Australian Research Council grant, is a collaboration among the University of New South Wales in Sydney Australia, the Australian Red Cross and the International Committee of the Red Cross. The project is unique in that it takes a mixed-methods approach, combining quantitative longitudinal data-collection methods and qualitative participatory-based research methods. The multiwave longitudinal study includes the development of a new measure of the impact of missing family members on refugees. This new measure – developed by academics, practitioners and refugees with lived experience – will likely complement ALI+. For more information, please visit the study website https://www.rtrp-research.com/prism-language-selection or email the research team at prism@unsw.edu.au.
