Grieving someone who is still here: understanding ambiguous loss

If your parent is changing and you feel a grief you cannot explain or justify, this is for you.

For most of her life, her mum read everything she wrote.

Reports, applications, anything that mattered. They would sit curled up at each end of the sofa, and her mum would find the things she had missed. A comma in the wrong place. A sentence that did not quite say what she meant. But it was never really about the grammar. Her mum read the work the way she read her daughter. Closely. Generously. With complete attention. She asked the question underneath the question. What did you mean here? Have you thought about it from their side?

A few years ago, she handed her mum something to check, the way she always had.

Her mum said, "Are you happy with it?"

She had been waiting for the pen to come out. For the questions. They did not come.

Her mum was sitting right there. Still gentle. Still here. And something that had always been there was not there now, and nobody else saw it go.

If you recognise this moment, in whatever form it took for you, then you already know the thing this article is about. You may not have had a name for it. Most women I work with do not. They tell me they feel flat after visits and cannot explain why. They tell me they cried in the car outside the house and felt ridiculous, because nothing had gone wrong. Their mum was fine. They were fine. Something was missing anyway.

What they are describing is grief. It has a name, a research base, and a reason it feels the way it does.

What ambiguous loss is

The term comes from Dr Pauline Boss, an American family therapist and researcher who began studying this form of loss in the 1970s and set out the theory in her book Ambiguous Loss: Learning to Live with Unresolved Grief (Harvard University Press, 1999). Boss identified a type of loss that our usual understanding of grief does not cover: losing someone who has not died.

She described two forms. The first is physical absence with psychological presence, where someone is gone but not confirmed lost, as with a missing person. The second is the one that concerns us here: psychological absence with physical presence. The person is still in the room. Still in their chair, still answering the phone, still recognisably themselves in a hundred ways. And yet parts of them, parts of the relationship, parts of who you were together, are no longer reachable.

Boss has called this one of the most difficult losses a person can face, precisely because it has no edges. There is no date it happened. There is no funeral. There is no moment when the world acknowledges that something has ended and gathers around you. The loss arrives in fragments, over years, and each fragment looks too small to grieve. A question that does not come. A pen that stays in the drawer. A conversation that stays on the surface where it used to go deep.

Grief research has historically been built around death, with its clear before and after. Researchers are now integrating ambiguous loss into grief models because dementia and cognitive change simply do not follow that shape. The loss is real, but the evidence for it is private. Often you are the only witness.

Why nobody calls it grief

There is a second layer to this, and it is the one that does the most quiet damage.

Grief for a living person is what researchers call disenfranchised grief: grief that is not socially recognised, so it receives none of the support that recognised grief does. Nobody sends a card. Nobody asks how you are coping with the loss, because as far as the world is concerned, there has been no loss. Your mum is still alive. You saw her on Sunday.

So the grief goes underground. And what I see in my work, again and again, is that it does not stay underground quietly. It comes out as exhaustion that sleep does not touch. As guilt that seems to attach itself to everything. As a flatness after visits that you start to dread, and then feel ashamed of dreading. As irritability with the people you love most. As the sense that you are failing at something, without being able to say what.

This matters at scale, not just individually. In the UK, around 2.4 million people are caring for both older and younger generations at once, and three in five of them are women, most aged between 45 and 64 (Dementia UK / Carers UK). Among unpaid carers of people with dementia specifically, 68% are women (Alzheimer's Society). That is an enormous population of women carrying a grief that has no name in their household, no line in their diary, and no recognition at work. Research also suggests women providing unpaid care are less likely to identify as carers at all (The Health Foundation), which means many are grieving a loss they have not acknowledged, in a role they have not acknowledged either.

The loss of who you are in their eyes

Within ambiguous loss there is one strand that is spoken about least, and it is the one that brought me to write this.

When a parent changes, we expect to grieve who they were. The cook, the gardener, the one who remembered every birthday. What takes most daughters by surprise is grieving who they were. Because some version of you existed only in your parent's seeing, and when their seeing changes, that version of you loses its home.

The woman in the story above did not lose a proofreader. She lost the one person who could catch what she was too tired or too self-critical to notice herself. Her mum's attention was a place she could return to when everything else felt uncertain. A house she could always go back to. All the times she felt less than, that gaze was where she went to be reminded otherwise.

Dementia, and the cognitive changes that often come before any diagnosis, take this first. Long before names are forgotten, the quality of attention changes. The follow-up questions stop coming. The person who used to hold your life up to the light and find what you had missed begins to ask polite questions that miss pertinent points that would be obvious to a different version of them.

This is why so many daughters tell me the early years are in some ways the hardest, which surprises people who assume grief tracks the severity of the condition. It does not. It tracks the relationship. And the relationship changes early.

Why it exhausts you the way it does

There is a nervous system dimension to this that almost nobody explains to carers, and it deserves to be understood.

Grief after a death is agonising, but the nervous system is at least responding to something finished. Ambiguous loss gives the nervous system an unsolvable problem. The person is here and not here. Each visit holds the possibility of a good day, a flash of the old connection, so part of you stays in hope. Each visit also holds fresh evidence of change, so part of you stays in mourning. Boss observed that people facing ambiguous loss fluctuate between hope and hopelessness, and that this fluctuation, sustained over years, is profoundly draining.

Your body never gets to stand down. You are grieving and hoping at the same time, often within the same hour, and both states cost energy. Add a job, children, a household, and the practical labour of caring itself, and you have the conditions in which burnout grows. Not because you are weak, and not because you are managing badly. Because you are doing something the human stress response was never designed to sustain: open-ended mourning with no resolution in sight.

This is also why the standard advice fails. You cannot "process" this grief to completion, because it is not complete. You cannot "find closure", because there is nothing to close. Boss herself argues that closure is a myth even in ordinary grief; in ambiguous loss it is an impossibility, and chasing it only adds failure to the load.

What actually helps

The aim is not to resolve this grief. The aim is to live well alongside it. Decades of research and clinical work, Boss's and others', point to some things that genuinely change how this is carried.

Name it. This sounds small. It is not. Grief that has a name can be felt without shame. The moment a woman stops asking "what is wrong with me?" and starts saying "I am grieving, and the grief is real", something in her body loosens. The energy that went into suppressing and second-guessing becomes available again.

Hold both truths at once. Boss calls this "both/and" thinking, and it is the core skill of living with ambiguous loss. My mum is here, and my mum is not here. I love her, and I am grieving her. I am her daughter, and I am also becoming something else to her. The mind wants to pick one. It does not have to. Both are true, and saying both out loud, even just to yourself, eases the tug of war.

Grieve the specific losses as they come. Not "I am losing my mum", which is too vast to hold, but the real, particular thing. The proofreading. The phone call after good news. The question underneath the question. Specific losses can be felt, marked, even honoured. Vast ones can only be braced against.

Find witnesses. Disenfranchised grief stays heavy because it is unwitnessed. One person who understands, a friend who has been there, a support group, a professional who knows this territory, changes the weight of it. You were never meant to be the only witness to this loss.

Notice what remains and what has moved inside you. This is not silver-lining talk, and it must never be rushed. But many daughters find, in time, that something of their parent's way of seeing now lives in them. The woman in the story still hears her mum's old voice when she writes, asking the question underneath the question. That is not a replacement for what was lost. It is evidence of how deeply she was seen, for how long.

The story in this piece comes from a relationship that was close and attentive. Not everyone's was. If yours was harder, more complicated, or painful, the loss is no less real, and it may carry its own particular weight. That too counts.

If this is you

You may have read this with a specific moment of your own in mind. The first time the pen stayed in the drawer, whatever the pen was in your family.

If so, I want you to take one thing from this page above everything else: what you are feeling counts. It does not need a diagnosis to be real. It does not need a death to be valid. It does not need anyone else's permission to matter.

And it does not have to be carried the way you are currently carrying it, silently, around the edges of everything else you hold.

I work with women who are grieving a parent who is still here, while running careers and families at the same time. If you would like a place to put this down for ninety minutes with someone who understands both the grief and the condition behind it, you can find out about working with me here.

Some days she would still give anything to sit at the other end of the sofa and watch the pen come out. She cannot have that. What she can have is her grief, named and held, taking up the space it was always owed.

References

• Boss, P. (1999). Ambiguous Loss: Learning to Live with Unresolved Grief. Harvard University Press.

• Boss, P. (2011). Loving Someone Who Has Dementia: How to Find Hope While Coping with Stress and Grief. Jossey-Bass.

• Boss, P. (2021). The Myth of Closure: Ambiguous Loss in a Time of Pandemic and Change. W. W. Norton.

• Dementia UK. What is a sandwich carer? dementiauk.org

• The Health Foundation. Unpaid care: the realities of caring in the UK. health.org.uk

• Alzheimer's Society, carer statistics on women and dementia care.

• National Council on Family Relations, Ambiguous Loss resource collection. ncfr.org