This is the time of the year when holiday shopping, decorations and celebrations exude an aura of happy anticipation: of family togetherness, of shared traditions, and of connecting through cards and other messages with far-flung friends and family. Why, then, does this time of the year bring feelings of yearning and sadness for some of us?

As we contemplate times of the year that revolve around family and memories of loved ones, it is natural for our thoughts also to turn to those loved ones who are unable to be with us. Whether because of illness, military duty, financial stress, conflicting obligations or other reasons, the absence of a loved one on a family oriented holiday can have a poignancy that is difficult to ignore. So what do we do with those thoughts of longing that cannot be satisfied?

Perhaps it would be helpful to distinguish between the different kinds of loss that we experience. I'll focus especially on ambiguous loss, anticipatory loss and anniversary reactions, as a way of communicating that each loss is unique and may need different kinds of comfort and self-soothing in the midst of the surrounding holiday happiness.

Ambiguous Loss, first conceptualized by Pauline Boss of the University of Minnesota, is loss that is not complete. She identifies that in mourning some losses, we may have the person physically present but emotionally absent (examples of that would be a loved one with Alzheimer's disease; chronic mental illness; addictions; brain injury or unconsciousness). The person's physical presence, while a poignant reminder of the loved one's previously more healthy self, is also a jarring disconnect from the person they have become. Likewise, another form of ambiguous loss occurs when the person is physically absent, but emotionally present (such as a person missing in action or in a natural disaster; kidnapped; incarcerated; or a runaway). In this kind of ambiguous loss the person, although not physically present, occupies a significant part of emotional devotion from those people who mourn that person's physical absence, and the waiting that is necessary before learning of a safe return.

Since I write this blog with special attention to people experiencing infertility and pregnancy loss, let me say that ambiguous loss is especially familiar in these circumstances: when you have built in your own mind an image of the baby you hope to have, which I think of as a "fantasy baby." This baby, although not physically present, is very real to you, but as each month passes without a pregnancy, your grief at feeling this fantasy baby slip away grows stronger. Conversely, a newborn baby can be present without the expected joyful emotional bonding. This might occur when a baby is born prematurely, since it is not the healthy, dimpled baby you had dreamed of cuddling and nursing but, instead, this infant is tiny and vulnerable, with its early life restricted to tubes and incubators. Under any of these circumstance, it is difficult to put a finger on what deserves to be mourned, especially as there is fear of loss, but no real closure or future yet to the relationship that you have been yearning for.

So ambiguous loss, especially during the holidays, represents both uncertainty and a changed perception from what we had anticipated as we looked to the future. In a sense we are relinquishing our hopes and dreams, sometimes putting our lives on hold, and trying to nourish relationships with friends and family who have some appreciation for the emotional dilemma that has become a part of our lives. Holiday time can be especially challenging, as we are aware of the "missing persons", either physically or emotionally, who are not with us as are so many other family members celebrating the holidays.

Anticipatory Loss refers to the mourning we begin to do when learning of a serious diagnosis for ourselves or for a loved one. Terminal illnesses can evoke anticipatory mourning, both for the patient and for loved ones. Other serous diagnoses, such as macular degeneration, loss of limbs, or mastectomies, can alter physical mobility and physical appearance while also increasing dependence on others. As we continue to anticipate the loss and its effect on our relationship with loved ones, we often are assailed with feelings of helplessness and hopelessness. It is not unusual to begin to withdraw emotionally from the loved one who is given a serious diagnosis, because it is so painful to contemplate the future. In truth, this mourning has some therapeutic strengths, in that we are not denying reality, so much as trying to make sense of it emotionally. We may reach out to others to vent our sadness and frustration, we may join support groups where others can share their own struggles and support us in ours. But as the loss becomes more inevitable, those of us who have had the courage to express our love in the midst of impending loss will feel the emotional load evolving, rather than imprisoning us.

Couples grappling with infertility face the issue of anticipatory mourning as they are told that a pregnancy is not healthy or viable, as they receive a diagnosis that means they will not be able to conceive a healthy child, and as they are told by infertility specialists that they have idiopathic (or "unexplained") infertility. They may gradually find themselves mourning the loss of the roles of birth parents and, instead, assessing whether they want to pursue other means of bringing children into their lives.

Holiday time, with so much emphasis on children, play, frivolity and fantasy, can grate on the hearts of people with infertility. In addition to the pain of not having a child to indulge at this time of the year, many people with infertility feel an undeserved sense of isolation, coupled with the fearful anticipation that birth parenthood may not be an option. Holiday time, with the coming together of distant friends and relatives who may not have seen one another for some time, also creates the awkwardness of questions about when you plan to have children or well-meaning warnings to be careful not to "wait too long."

Anniversary Reactions: This is a reminder that on the anniversary of a loss, we possibly will have some kind of emotional reaction. Whenever I find myself feeling unexpectedly gloomy or inexplicably introspective, I have learned to ask myself whether I am approaching or in the midst of the anniversary of an emotional loss. Ninety percent of the time that what is happening. Sometimes the anniversary will be of a loved one's death, birthday, wedding anniversary, or other special occasion when I would have picked up the telephone or sent a cheerful card. Other times, the anniversary may be a celebratory holiday when the loved one would have gathered with family in the days he or she was alive and healthy. I have learned over time that what works best for me is to anticipate an anniversary that may be associated with the loss of a loved one. I try to be especially kind to myself at those times, sometimes sharing my thoughts with friends or family members, or other times just creating quiet times for myself to be contemplative and to dwell on happy memories. For people who may not have completed their grief at the loss of a loved one, it is more likely that an anniversary will evoke feelings of sadness. This is especially true if the loss is an ambiguous loss, with closure feeling impossible and memories feeling unresolved.

For couples with infertility, anniversary reactions can mark such times as the beginning of infertility treatment (and accompanying disbelief that so much time has passed without a conception); a pregnancy loss (which, for many, will represent a continuing emotional attachment); a failed adoption; or a decision to move on to a child free life. The importance of being aware of these emotionally-charged anniversaries is that one can honor the past hopes and dreams while, at the same time, feeling invested in the new directions life may be taking. Holiday time tends to be felt as a reminder of last year's anniversary, when one or both members of the couple held out hopes that by "this time" next year they might be cuddling an infant in their arms. As they watch nieces and nephews grow older with each holiday, it reinforces for them the passage of time and the diminishing likelihood that any baby born to or adopted by them will have current nieces and nephews as age-mates.

So, just as we may now understand the mix of holiday joy with the flip side of remembering absent loved ones, what do we do with that awareness? Of course each of us will handle the emotion of sadness differently. First it is important simply to acknowledge to yourself that joy and grief can co-exist. It is also helpful to find some quiet time to indulge your memories of the loved ones who are not able to share the joys of the holidays with you. Perhaps this also can include a more public sharing, such as reminiscences with others of the absent loved one, the baking of that person's favorite holiday goodies, or the displaying of a photograph or possession that evokes memories of happier times together. And then, in the midst of what can become a hectic holiday, it is helpful to slow down enough to absorb the memories in a calm way. Playing soothing music, soaking in a warm tub, getting a massage, getting extra sleep, taking a peaceful walk, or doing a kindness for another person all constitute opportunities to change the rhythm of the holidays to a more calm and reflective time.

So in the spirit of finding some emotional balance in the midst of busy holiday celebrations, I wish you peacefulness as you find a path, and perhaps some company, to soothe your emotions in this celebratory season.

About the Author

Connie Shapiro PhD

Connie Shapiro, Ph.D., is a professor of family studies at the University of Illinois at Urbana-Champaign and author of When You're Not Expecting: An Infertility Survival Guide.

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