When a catastrophe like a brain injury first happens, time is taken up—sometimes for years—with rehabilitation. But what happens once that has reached its conclusion, and there are still deficits, some permanent? These losses are nebulous and tricky, and psychology calls the state “ambiguous loss.”
Dr. Lori Weissman, a therapist with over 40 years treating brain-injured clients, explains the scenario in a Brain Injury Alliance of Washington (BIAWA) podcast. While getting injured, being hospitalized, and going through lots of rehab isn’t hard enough, she adds another element to the loss: the person looks the same, yet isn’t, which is confusing.
“Existing in the not-knowing of our current lives feels untenable and unsustainable. Many are fortunate and regain all of their skills. But there are many, as we well know, that have deficits that still linger. And so their personalities change, how they think and do things changes. This is a loss of who the person was, so it’s very confusing. The person is still there, they pretty much look as they did prior to their injury, but who’s they did things, how they behave, the nature of relationships have changed. This is one of the biggest adjustments that people go through,” says Weissman.
Ambiguous Loss Has No Healing Rituals
Most types of loss, particularly those involving death, have various rituals like funerals and memorials — things that help mourners cope. But, with ambiguous loss, these rituals don’t apply. In the case of a brain injury, there hasn’t been a death, but the person can be irrevocably altered. Sometimes, according to Weissman, these losses are delayed by years.
“When the injured person realizes they’re different, there’s a lot of shame and embarrassment that is an obstacle for them being able to talk about what’s happening. Many feel they should be able to overcome this and there’s something wrong with them,” Weissman says.
The uncertainty and lack of closure from ambiguous loss is daunting. Weissman believes it cannot be overcome alone. She recommends a therapist with ample experience in brain injuries and ambiguous loss. There’s more of a feeling curve than a learning curve in this process, so it’s not about setting goals and moving on. It’s more about “learning how to navigate what is and grieving what was.”
Finding Resilience and the “Warrior Spirit”
Many people aren’t as sorely tested as those with brain injuries. The COVID-19 pandemic, though, is giving the whole world a peek at what ambiguous loss feels like.
“Ambiguous loss prompts an especially challenging kind of grief: It is confusing, and disorienting, and defies popular ideas about ‘closure.’ In other words, there is no clear “end” to the current COVID-19 pandemic — and that’s part of what makes our emotional experience of this disease so taxing. Existing in the not-knowing of our current lives feels untenable and unsustainable,” says Psychology Today.
One crucial coping mechanism is resilience. “The person’s heart and soul is intact,” Weissman explains. She calls the process “developing the emotional muscle of resilience.”
Another term BIAWA uses is the “warrior spirit.” By learning how to grieve the loss and changes, and emerge whole, hope returns. “What I want people to really know is that they are the warriors. The fact that they are breathing, standing, and eating and sleeping, and engaging with people means they’re more than survivors, they are warriors,” says Weissman.
Some useful exercises, which apply to brain injuries and COVID-19 stresses alike, are things like journaling as a tool to “mark” feelings and progress. Trying to remain active within community is also key. Having a small inner circle of supportive family and friends, who fully understand the situation and will simply listen, helps immensely. Self reflection can also lead to massive growth, according to Weissman.
“You can hold loss and acceptance and hope simultaneously,” says Weissman. “True healing is an inside job. It’s between you and you.”