Ambiguous Loss and Cancer
Hester Hill Schnipper, LICSW, OSW-C Program Manager Emeritus, Oncology, Social Work
AUGUST 10, 2022
The concept of ambiguous loss feels very relevant for anyone living with cancer. Our lives are changed, to a greater or lesser degree, by the diagnosis and treatment. It is always traumatic to receive a cancer diagnosis, but it is certainly worse with some diagnoses than with others. It is a mistake to set up comparisons among cancer patients; everyone’s experience is unique and challenging.
No matter what the statistics may be...we are each an n of one, and are forced to live with ambiguity.
A theory pioneered by Pauline Boss says that there are two kinds of ambiguous loss. The first is physical absence with psychological presence; this describes when someone is missing from war, kidnapping, or another horrific situation, as well as more common situations such as distance or absence due to divorce or a long-distance move.
The second type occurs when there is psychological absence with physical presence. This can happen with dementia, addiction, or other serious mental health problems. Dr. Boss also suggests that psychological ambiguous losses can happen after events that never make sense and hurts that never fully heal; these could include suicide or loss of a child.
What does this have to do with us? I think that a broader and more flexible view of this term includes situations, like ours, when it may be unclear exactly what has been lost and may not ever have definitive closure. Cancer, as well as other chronic illnesses, may put us in situations that seem to devalue our sense of self and keep us uncertain and struggling to understand our losses. All of us, at the moment of diagnosis, lose our immediate good health and much of our agency; life suddenly seems out of control and very uncertain.
With cancer, we may lose our ability to sustain our usual personal and professional obligations; we may lose some friends; we may lose a body part or our hair. And we don’t know what might be around the corner and how to prepare for possible future blows. The biggest worry, of course, is whether cancer is going to end in the loss of our life. For all of us, this results in some level of anxiety or sadness, but most of us find ways to manage our lives and our feelings.
How do we learn how to cope? One measure of good mental health is the capacity to hold multiple truths simultaneously. For example, one can understand that opting for a mastectomy is the wise choice while still grieving the loss of a breast. One feeling does not cancel out the other.
This applies to much about living with cancer, both during the months of treatment and in the later months and years of survivorship. We can feel reassured that we have had excellent treatment and are likely to stay well, but we understand that this is never a promise. No matter what the statistics may be, no matter what our doctors have told us about a prognosis, we are each an n of one, and are forced to live with ambiguity.
The best way to learn to cope with ambiguity, or at least the best way that I know, is to adopt Both-And thinking. We can consciously practice this perspective and train ourselves to more easily feel both the loss and the hope. We never need to be trapped in Either-Or thinking, which can make us limited and rigid in our thoughts.
Instead of thinking: I feel awful from the chemo, but that is the way it is, we can think: This chemo makes me feel awful, and I will feel better in the future. Or, rather than thinking: But people sometimes die from this disease, we can remind ourselves: Lots of people stay well.
It may seem like a small trick, but it can be a powerful one. Hold on to more than one feeling and change those but’s to and’s as you remind yourself of the possible good outcomes and better times ahead.