‘Ambiguous loss’ disenfranchises the normal grief process and leads to a prolonged ‘vacillating grief’. A grief which vacillates between hope and despair. The lack of a closure, mitigating any efforts to move on through the interplay of guilt and the denial of the inevitable. An intense helplessness and perpetual suffering that struggles to make sense of the predicament and to attain cognitive consonance in the midst of uncertainty. The phenomenon captured by the term “living in limbo” (Holmes, 2008).
Lack of closure is fundamental and a recent study from Sri Lanka showed that even subsequent confirmation of death prevented psychological morbidity in the form of depressive disorder and prolonged grief (6). In 20 out of the 24 interviewed, no religious or farewell ceremonies had been performed for the missing person. Such ceremonies undoubtedly facilitate closure(9, 10).
Family members of missing individuals often reject offers of death certificates or accept reparations, since it is contrary to their hope due to the lack of closure.
In Sri Lankan culture, people turn to fortune tellers to know the possible outcome during uncertainty. The false information provided by fortune tellers, renews hope. This further confounds the situation and leads to a renewed effort to seek out the missing person spending large sums of money by selling their property or borrowing.
Bowlby described that failed attempts to restore missing relationships often results in perpetual distress and agony (11). This perpetual suffering was evident in our findings. It had psychological and psychosomatic ramifications. The higher risk of developing physical and mental illness in the context of chronic stress is well documented (5).
Studies on psychological consequences of family members of missing persons are limited (5). A study done in Bosnia and Herzegovina reported that symptoms of post-traumatic stress disorder(PTSD) was significantly higher in wives of missing individuals than in those who had been exposed to other traumatic experiences during the political unrest in their country (12). Most of the research looking at psychological morbidity has focused on PTSD. But, ambiguous loss is essentially a relational issue and the trauma is ongoing.
A study done by ICRC in Sri Lanka reported that family members of missing individuals experience a high level of psychological morbidity. Of 321 participants, 51% showed anxiety symptoms, 58% showed symptoms of depression and 15% showed symptoms of PTSD (13). Professor Pauline Boss showed that people who experience ambiguous loss are at a higher risk of developing depression, anxiety disorders, and substance use disorders (1, 14). However, these studies focused on symptoms of mental illnesses and categorical diagnoses was not made.
Caution should be exercised when making a diagnosis in family members of missing persons. When they are screened for depressive disorder, prolonged grief disorder or PTSD, it should be kept in mind that symptoms of ambiguous loss can be attributed to mental disorders. On the other hand, most symptoms of depression, prolonged grief disorder and PTSD tend to overlap (15).
Survivor guilt impedes on enjoying life as before. Family members left behind believe that they give up on the missing person if they started living normally. They do not attend festive events such as weddings and do not cook food that they prepare for festive events. This creates self-imposed barriers to their happiness.
Role of Gender
There is a gendered impact on disappearances (16). When the disappearances occur in the context of civil conflicts the majority of disappeared persons are males (16). Therefore, the economic, social and psychological impact on female family members is relatively high (17, 18).
Disappearances cause greater impact on older females (16). In most cultures, children, especially male children, support their parents in their senior ages. When their children become unaccounted for, they are deprived of security and financial support which could have been received if their missing son had lived with them (16).
Wives face the dual challenge of managing the family responsibilities in the absence of the missing husband, and the grief stemming from the loss (16). There can be many bureaucratic hurdles in accessing the husband’s salary, bank account, and other properties in the absence of a death certificate (16). In some cultures, bodily markings are used to signify the status of marriage. In Tamil culture in Sri Lanka, married women are expected to wear ‘thali’ (a jewellery item) and kungumappottu (a red mark on the forehead) (16). When a widow or a wife of a disappeared person wears such bodily markings, the symbols are considered as an ill omen. As a result, wives of missing persons do not enjoy the same privileges as their married counterparts, which may discourage them from attending public events (16).
Families in southern Sri Lanka live with their extended family which can be helpful in many ways in the face of adversities. At the same time, living with an extended family can be a great source of stress as well. The majority of interviewees in our study identified that their family members are helpful when coping with the stress of ambiguous loss. However, some mothers whose sons went missing reported that family members blame them and remove the photograph of the missing son as they are always mourning looking at the son’s photograph.
When a family member is physically absent, but psychologically present most of the time, the family members’ perception of who is inside or outside the family system is blurred. Ambiguous loss confuses boundaries of family members resulting in boundary ambiguity. Most of the missing individuals are young males in southern Sri Lanka (5). In Sri Lankan culture, male partners ensure the protection of the family. In their absence, families feel that they are not safe as before (13). In the absence of the breadwinner of the family, others have to take the responsibility of earning money which can be quite challenging. Hence ambiguous loss disturbs relationships and dynamics of everyday life in the family.
It should be noted that there may have been other losses and stressful events which may have cumulatively affected the grieving process. The sampling is from a specific geographical location and socio-cultural context.
There is also a possibility that the researcher could have been perceived as someone who could deliver assistance or compensation to the interviewees. This could lead to exaggeration of the impact of the disappearance. Some families were involved in socio-political activities to determine the truth or seek justice with regard to the missing individual.