Living Loss: A Hidden Form of Grief

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We often associate grief with death. However, we can also experience grief when significant changes occur in our relationships with living people. These experiences are called living losses, and they can be just as painful and difficult to cope with as the grief we experience after a death.

What is Living Loss?

Living loss occurs when someone or something important in your life remains physically present, but their role or relationship with you has fundamentally changed. This can happen due to various circumstances, such as family estrangement, chronic illness or disability, addiction, or aging and cognitive decline of loved ones.

A living loss is similar to the concept of ambiguous loss, a term coined by Dr. Pauline Boss (1999) to describe the uncertainty family members face when a loved one is psychologically or physically gone, but not necessarily deceased.

There are two types of ambiguous losses:

1. Physical presence with psychological absence: The person is still present, but they are no longer cognitively, emotionally, or psychologically available. For example, a loved one is experiencing cognitive decline or mental illness.
2. Physical absence with psychological presence: The person is not physically present in your life, but an emotional connection remains. For example, when a loved one is incarcerated or missing.

Types of Living Losses

Living loss can manifest in many life experiences, often in ways that go unrecognized or unacknowledged by society. Here are some common examples:

• Chronic illness or disability: When a loved one is diagnosed with a chronic or terminal illness, caregivers and family members may grieve the loss of the person they once knew.
• Mental illness or addiction: These illnesses can profoundly change a person's personality and behavior, leading to emotional or physical distance and impairing their ability to have a mutually satisfying and reciprocal relationship with you.
• Cognitive decline or dementia: Watching a loved one lose their memory and cognitive abilities creates a deep sense of loss, as the person they were gradually fades away while their physical presence remains.
• Estrangement: Being estranged from a family member, even by choice, involves not just the loss of specific relationships, but your role in the family, shared history, a safety net, and the dream of having a loving family.
• Divorce or separation: The end of a marriage or long-term relationship is a living loss, as the person you were once intimately connected to continues to exist, but the nature and closeness of the relationship has changed.
• Parenting a child with special needs: For parents of children with special needs, there can be an element of living loss as they adjust to the reality that their child may not have the life they envisioned.

Why Grieving a Living Loss is Difficult

Grieving a living loss is complex for several reasons:

• Lack of social support: Most people receive lots of support when a loved one dies. Unfortunately, this is rarely the case for a living loss. Friends don’t typically send cards or bring casseroles when your son is incarcerated, or your wife’s memory is failing. Nor are there formal rituals, like funerals, to acknowledge the loss. As a result, many feel alone and unsupported when they endure a living loss.
• Stigma: Living losses are often sources of social stigma, which create feelings of guilt, shame, and isolation for those experiencing them.

• Ambiguous nature: The ambiguous and ongoing nature of living loss makes it difficult to find closure. For example, you may not know if a person who is physically absent will ever return, an estranged relationship will be reconciled, or an ill loved one will recover.
• Identity struggles: Living losses often involve the loss of roles or identities. These identity shifts complicate the grieving process and create confusion about one’s sense of self.

How to Grieve a Living Loss

While grieving a living loss can be challenging, there are ways to facilitate a healthier grieving process:

• Validate your feelings: The first step in healing is to recognize that what you are experiencing is a valid form of grief. Make space for your feelings and try not to minimize them.
• Name your losses: Because living losses are often unacknowledged, it’s helpful to explicitly name what you’ve lost. Naming a loss makes it more tangible and allows you to confront your feelings head-on.
• Create personal rituals: Living losses typically lack the formal rituals of death, like funerals. Creating your own rituals can help provide symbolic closure or comfort. Ideas include journaling, meditating, or lighting a candle.
• Seek support: Grieving a living loss can feel isolating, especially if others don’t understand your experience. Seeking support from a therapist, counselor, or support group can help you process your emotions.
• Practice self-compassion: Be kind to yourself; grieving is hard.
• Focus on what you can control: Reclaim a sense of agency by focusing on what you can control.
• Redefine the relationship: Grieving a living loss often requires adjusting your expectations and redefining how you connect. For example, with Alzheimer's, you might focus on what's good about the present and try to let go of past versions of your loved one.
• Meaning-making: You might reflect on how you’ve grown through the loss or how you’ve learned to appreciate life in new ways. Meaning-making doesn’t erase the pain, but it can help you move forward with a sense of purpose.

Grieving a living loss can be difficult as it’s often misunderstood or minimized. Prioritize acknowledging your feelings, seeking support, and self-compassion. As you move through the process, you’ll learn to tolerate the uncertainty, redefine your relationship, and find meaning in your experiences—all of which build resilience and help you cope.