Ambiguous Losses and Their Traumatic Effects: A Qualitative Synthesis of the Research Literature

Yıl 2024, Cilt: 15 Sayı: 2, 721 - 755, 28.08.2024

Hadiye Küçükkaragöz , Ruşen Meylani

https://doi.org/10.51460/baebd.1474742

Öz

This paper presents a comprehensive review of the research literature on ambiguous losses, focusing on the psychological impact of uncertainty and the associated unresolved circumstances. The research method involves synthesizing data from various sources, including academic articles, books, and case studies, accessed through databases like PubMed, Scopus, Web of Science, and PsycINFO. The study underscores the need for specialized therapeutic methods and comprehensive support systems to improve the resilience and psychological health of those experiencing ambiguous loss. Effective coping strategies include seeking social support, engaging in meaning-making activities, and using therapeutic interventions like resilience training and narrative therapy to improve the psychological health of those experiencing ambiguous loss. Healthcare providers should integrate narrative therapy and resilience training techniques, while social workers should enhance support systems involving community networks. Further research is urgently advocated to expand the understanding of ambiguous loss across various contexts and cultures, leading to more effective, tailored interventions. The study's contributions are significant, as it elucidates the complex dynamics of ambiguous loss and identifies effective coping mechanisms and therapeutic interventions. By highlighting how ambiguous loss differs from other losses in closure and resolution, the paper offers new insights into the tailored approaches necessary to support affected individuals. The study consolidates diverse aspects of ambiguous losses and makes unique suggestions for policy and practice in one scholarly work.

Anahtar Kelimeler

Ambiguous Losses, Traumatic Effects, Coping Mechanisms, Resilience Training, Family Therapy, Narrative Therapy, Psycho-social Interventions

Muğlak Kayıplar ve Bunların Travmatik Etkileri: Alan Yazının Nitel Bir Sentezi

Öz

Bu makale muğlak kayıplara ilişkin araştırma literatürünün kapsamlı bir incelemesini sunarak, belirsizlik ve bunlarla ilişkili çözümlenememiş durumların psikolojik etkisine odaklanmaktadır. Araştırma yöntemi, betimsel, yenilikçi sistematik taramadır. Veriler, PubMed, Scopus, Web of Science ve PsycINFO gibi veri tabanları aracılığıyla erişilen akademik makale, kitap ve vaka çalışmaları dahil olmak üzere çeşitli basılı ve görsel kaynaklardan elde edilmiştir. Veriler içerik analizi yoluyla analiz edilerek sentezlenmiştir. Veri analizi sonuçları, muğlak kayıplar yaşayanların dayanıklılığını ve psikolojik sağlığını iyileştirmek için özel tedavi yöntemlerine ve kapsamlı destek sistemlerine duyulan ihtiyacı vurgulamaktadır. Muğlak kayıpla etkili başa çıkma stratejileri arasında sosyal destek, anlam oluşturma faaliyetleri, dayanıklılık eğitimi ve anlatı terapisi gibi müdahaleler yer almaktadır. Psikolojik danışma ve diğer psiko-sosyal destek hizmeti sağlayıcıları, anlatı terapisi ve dayanıklılık eğitimi gibi yöntem ve tekniklerini entegre ederek, çeşitli toplulukları içeren destek sistemleri geliştirilmelidir. Muğlak kayıplarla ilgili anlayışı, farklı bağlam ve kültürler arasında genişleterek etkili, özel müdahale yöntemleri geliştirebilmek için daha fazla araştırma yapılmasının acilen gerektiği de savunulmaktadır. Bu çalışmanın, muğlak kayıpların karmaşık dinamiklerini açıklayarak etkili başa çıkma mekanizmalarını ve müdahale yöntemlerini tanımlamakta olması nedeniyle alan yazına katkılarının önemli olduğu düşünülmektedir. Elde edilen sonuçlara göre, muğlak kayıpların, çözümleme ve kabullenme açısından diğer kayıplardan farklı olduğu vurgulanmakta, etkilenen bireyleri desteklemek için gereken özel yaklaşımları geliştirmek üzere yeni bakış açıları sunulmaktadır. Sonuç olarak bu makalede, alanda yapılan farklı çalışmaklar da ele alınarak muğlak kayıpların çeşitli yönleri bütüncül bir bakış açısıyla irdelenmekte, ruh sağlığı uygulamacılarına ve politika yapıcılara yenilikçi önerilerde bulunulmaktadır.

Anahtar Kelimeler

Muğlak Kayıplar, Travmatik Etkiler, Başa Çıkma Mekanizmaları, Direnç Eğitimi, Aile Terapisi, Anlatı Terapisi, Psiko-sosyal Müdahaleler

Kaynakça

• Ahmed, S. K., Chandran, D., Hussein, S., Sv, P., Chakraborty, S., Islam, M. R., & Dhama, K. (2023). Environmental health risks after the 2023 Turkey–Syria earthquake and salient mitigating strategies: A critical appraisal. Environmental Health Insights, 17, 11786302231200865. doi:10.1177/11786302231200865
• Barber, B. K. (2013). Annual Research Review: The experience of youth with political conflict – Challenging notions of resilience and encouraging research refinement. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 54(4), 461–473. doi:10.1111/jcpp.12056
• Betz, G., & Thorngren, J. M. (2006). Ambiguous loss and the family grieving process. The Family Journal, 14(4), 359–365. doi:10.1177/1066480706290052
• Blieszner, R., Roberto, K. A., Wilcox, K. L., Barham, E. J., & Winston, B. L. (2007). Dimensions of ambiguous loss in couples coping with mild cognitive impairment. Family Relations, 56(2), 196–209. doi:10.1111/j.1741-3729.2007.00452.x
• Boss, P. (2010). The trauma and complicated grief of ambiguous loss. Pastoral Psychology, 59(2), 137–145. doi:10.1007/s11089-009-0264-0
• Boss, P. (2016). The context and process of theory development: The story of ambiguous loss. Journal of Family Theory and Review, 8(3), 269–286. doi:10.1111/jftr.12152
• Boss, P., & Greenberg, J. (1984). Family boundary ambiguity: A new variable in family stress theory. Family Process, 23(4), 535–546. doi:10.1111/j.1545-5300.1984.00535.x
• Boss, P. G. (2002). Ambiguous loss: Working with families of the missing. Family Process, 41(1), 14–17. doi:10.1111/j.1545-5300.2002.40102000014.x
• Chase, B. (2022). The unexpected comfort of feeling it all: A support group for mothers of autistic adolescents using the lens of ambiguous loss. Clinical Social Work Journal, 50(4), 436–444. doi:10.1007/s10615-022-00834-2
• Chen, S.-C., Wu, S.-F., Wang, T.-J., Rosenberg, J., Lu, Y.-Y., & Liang, S.-Y. (2022). Factors influencing the coping strategies of liver cancer patients undergoing transarterial chemoembolization. International Journal of Nursing Practice, 28(4), e13033. doi:10.1111/ijn.13033
• Cohen, S., & Wills, T. A. (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98(2), 310–357. doi:10.1037/0033-2909.98.2.310
• Comtesse, H., Killikelly, C., Hengst, S. M. C., Lenferink, L. I. M., de la Rie, S. M., Boelen, P. A., & Smid, G. E. (2023). The ambiguous loss inventory plus (ali+): Introduction of a measure of psychological reactions to the disappearance of a loved one. International Journal of Environmental Research and Public Health, 20(6), 5117. doi:10.3390/ijerph20065117
• Faulk, K. E., Gloria, C. T., & Steinhardt, M. A. (2013). Coping profiles characterize individual flourishing, languishing, and depression. Anxiety, Stress, and Coping, 26(4), 378–390. doi:10.1080/10615806.2012.708736
• Helps, S. (2023). Editorial. Journal of Family Therapy, 45(2), 135-137. https://doi.org/10.1111/1467-6427.12428
• Hikichi, H., Aida, J., Kondo, K., Tsuboya, T., Matsuyama, Y., Subramanian, S. V., & Kawachi, I. (2016). Increased risk of dementia in the aftermath of the 2011 Great East Japan earthquake and tsunami. Proceedings of the National Academy of Sciences of the United States of America, 113(45), E6911–E6918. doi:10.1073/pnas.1607793113
• Huebner, A. J., Mancini, J. A., Wilcox, R. M., Grass, S. R., & Grass, G. A. (2007). Parental deployment and youth in military families: Exploring uncertainty and ambiguous loss. Family Relations, 56(2), 112–122. doi:10.1111/j.1741-3729.2007.00445.x
• Hugelius, K., Adolfsson, A., Örtenwall, P., & Gifford, M. (2017). Being both helpers and victims: Health professionals’ experiences of working during a natural disaster. Prehospital and Disaster Medicine, 32(2), 117–123. doi:10.1017/S1049023X16001412
• Jeter, K., & Turns, B. (2022). Grieving the child that never was: Treatment of ambiguous loss in parents of children with Down syndrome. Australian and New Zealand Journal of Family Therapy, 43(2), 243–256. doi:10.1002/anzf.1488
• Kamaludin, K., Chinna, K., Sundarasen, S., Khoshaim, H. B., Nurunnabi, M., Baloch, G. M., . . . Hossain, S. F. A. (2020). Coping with COVID-19 and movement control order (MCO): Experiences of university students in Malaysia. Heliyon, 6(11), e05339. doi:10.1016/j.heliyon.2020.e05339
• Kaplow, J. B., Layne, C. M., Saltzman, W. R., Cozza, S. J., & Pynoos, R. S. (2013). Using multidimensional grief theory to explore the effects of deployment, reintegration, and death on military youth and families. Clinical Child and Family Psychology Review, 16(3), 322–340. doi:10.1007/s10567-013-0143-1
• Kim, J., & Tucker, A. (2020). The inclusive family support model: Facilitating openness for post‐adoptive families. Child and Family Social Work, 25(1), 173–181. doi:10.1111/cfs.12675
• Knight, C., & Gitterman, A. (2019). Ambiguous loss and its disenfranchisement: The need for social work intervention. Families in Society, 100(2), 164–173. doi:10.1177/1044389418799937
• Kotzé, M., Visser, M., Makin, J., Sikkema, K., & Forsyth, B. (2013). Psychosocial variables associated with coping of HIV-positive women diagnosed during pregnancy. AIDS and Behavior, 17(2), 498–507. doi:10.1007/s10461-012-0379-7
• Kreutzer, J. S., Mills, A., & Marwitz, J. H. (2016). Ambiguous loss and emotional recovery after traumatic brain injury. Journal of Family Theory and Review, 8(3), 386–397. doi:10.1111/jftr.12150
• Lang, A., Fleiszer, A. R., Duhamel, F., Sword, W., Gilbert, K. R., & Corsini‐Munt, S. (2011). Perinatal loss and parental grief: The challenge of ambiguity and disenfranchised grief. Omega, 63(2), 183–196. doi:10.2190/OM.63.2.e
• Machida, M., Irwin, B., & Feltz, D. (2013). Resilience in competitive athletes with spinal cord injury: The role of sport participation. Qualitative Health Research, 23(8), 1054–1065. doi:10.1177/1049732313493673
• Matsuda, Y., Takebayashi, Y., Nakajima, S., & Ito, M. (2021). Managing grief of bereaved families during the COVID-19 pandemic in Japan. Frontiers in Psychiatry, 12, 637237. doi:10.3389/fpsyt.2021.637237
• Mavrouli, M., Mavroulis, S., Lekkas, E., & Tsakris, A. (2023). An emerging health crisis in Turkey and Syria after the earthquake disaster on 6 February 2023: Risk factors, prevention and management of infectious diseases. Healthcare, 11(7), 1022. doi:10.3390/healthcare11071022
• Mechling, B. M. (2015). A cross‐sectional survey of the effect on emerging adults living with a depressed parent. Journal of Psychiatric and Mental Health Nursing, 22(8), 570–578. doi:10.1111/jpm.12244
• Moradi, A., Nabi Bidhendi, G. R., & Safavi, Y. (2021). Effective environment indicators on improving the resilience of Mashhad neighborhoods. International Journal of Environmental Science and Technology, 18(8), 2441–2458. doi:10.1007/s13762-021-03377-0
• Mulyasari, G., Trisusilo, A., & Windirah, N. (2023). Resilience to climate change among small-scale fishery on the Northern Coastal of Bengkulu Province, Indonesia. E3S Web of Conferences, 373. doi:10.1051/e3sconf/202337302001
• Parviniannasab, A. M., Rakhshan, M., Momennasab, M., Soltanian, M., Rambod, M., & Akbarzadeh, M. (2022). The mediating role of courageous coping in the relations between spirituality and social support with resilience among adolescents with hemophilia. Clinical Child Psychology and Psychiatry, 27(4), 1141–1154. doi:10.1177/13591045211055081
• Phillips, B. (2024). Caring for a child with an acquired disability: Unveiling Light From Darkness. ANS. Advances in Nursing Science, 47(1), 89–103. doi:10.1097/ANS.0000000000000488
• Powell, K. A., & Sorenson, A. (2020). Ambiguous loss after shaken baby syndrome/abusive head trauma: Parental management of dialectical contradictions of grief. Communication Quarterly, 68(3), 243–264. doi:10.1080/01463373.2020.1759112
• Ratajová, K., Blatný, J., Poláčková Šolcová, I., Meier, Z., Horňáková, T., Brnka, R., & Tavel, P. (2020). Social support and resilience in persons with severe haemophilia: An interpretative phenomenological analysis. Haemophilia, 26(3), e74–e80. doi:10.1111/hae.13999
• Renner, A., Jäckle, D., Nagl, M., Plexnies, A., Röhr, S., Löbner, M., . . . Kersting, A. (2021). Traumatized Syrian refugees with ambiguous loss: Predictors of mental distress. International Journal of Environmental Research and Public Health, 18(8), 3865. doi:10.3390/ijerph18083865
• Rowe, C. L., & Liddle, H. A. (2008). When the levee breaks: Treating adolescents and families in the aftermath of Hurricane Katrina. Journal of Marital and Family Therapy, 34(2), 132–148. doi:10.1111/j.1752-0606.2008.00060.x
• Sharp, P., Oliffe, J. L., Kealy, D., Rice, S. M., Seidler, Z. E., & Ogrodniczuk, J. S. (2023). Social support buffers young men’s resilient coping to psychological distress. Early Intervention in Psychiatry, 17(8), 784–791. doi:10.1111/eip.13371
• Soeterik, S. M., Connolly, S., Playford, E. D., Duport, S., & Riazi, A. (2017). The psychological impact of prolonged disorders of consciousness on caregivers: A systematic review of quantitative studies. Clinical Rehabilitation, 31(10), 1374–1385. doi:10.1177/0269215517695372
• Solheim, C., Zaid, S., & Ballard, J. (2016). Ambiguous loss experienced by transnational Mexican immigrant families. Family Process, 55(2), 338–353. doi:10.1111/famp.12130
• Soqia, J., Ghareeb, A., Hadakie, R., Alsamara, K., Forbes, D., Jawich, K., . . . Kakaje, A. (2023). The mental health impact of the 2023 earthquakes on the Syrian population: Cross-sectional study. BJPsych Open, 10(1), e1. doi:10.1192/bjo.2023.598
• Tsuboya, T., Aida, J., Hikichi, H., Subramanian, S. V., Kondo, K., Osaka, K., & Kawachi, I. (2016). Predictors of depressive symptoms following the Great East Japan earthquake: A prospective study. Social Science and Medicine, 161, 47–54. doi:10.1016/j.socscimed.2016.05.026
• Walsh, F. (2003). Family resilience: A framework for clinical practice. Family Process, 42(1), 1–18. doi:10.1111/j.1545-5300.2003.00001.x
• Walsh, F. (2020). Loss and resilience in the time of COVID-19: Meaning making, hope, and transcendence. Family Process, 59(3), 898–911. doi:10.1111/famp.12588
• Williams, J. M., & Spruill, D. A. (2005). Surviving and thriving after trauma and loss. Journal of Creativity in Mental Health, 1(3–4), 57–70. doi:10.1300/J456v01n03_04
• Windle, G. (2011). What is resilience? A review and concept analysis. Reviews in Clinical Gerontology, 21(2), 152–169. doi:10.1017/S0959259810000420
• Wise, T., Zbozinek, T. D., Charpentier, C. J., Michelini, G., Hagan, C. C., & Mobbs, D. (2023). Computationally-defined markers of uncertainty aversion predict emotional responses during a global pandemic. Emotion, 23(3), 722–736. doi:10.1037/emo0001088
• Yin, Y., Lyu, M., Chen, Y., Zhang, J., Li, H., Li, H., . . . Zhang, J. (2022). Self-efficacy and positive coping mediate the relationship between social support and resilience in patients undergoing lung cancer treatment: A cross-sectional study. Frontiers in Psychology, 13, 953491. doi:10.3389/fpsyg.2022.953491
• Yu, M., Wang, H., & Xia, G. (2021). The review on the role of ambiguity of tolerance and resilience on students’ engagement. Frontiers in Psychology, 12, 828894. doi:10.3389/fpsyg.2021.828894
• Zaksh, Y., Yehene, E., Elyashiv, M., & Altman, A. (2019). Partially dead, partially separated: Establishing the mechanism between ambiguous loss and grief reaction among caregivers of patients with prolonged disorders of consciousness. Clinical Rehabilitation, 33(2), 345–356. doi:10.1177/0269215518802339
• Zucca, A. C., Boyes, A. W., Lecathelinais, C., & Girgis, A. (2010). Life is precious and I’m making the best of it: Coping strategies of long-term cancer survivors. Psycho-Oncology, 19(12), 1268–1276. doi:10.1002/pon.1686