This is a part of the Hot Topic podcast series from the Model Systems Knowledge Translation Center on Relationships After TBI. Dr. Jeffrey S. Kreutzer discusses Ambiguous Loss.

Ambiguous loss is a topic that I have thought a lot about for several years. And it was actually one of my students who started talking about ambiguous loss and one of my students talked about it. She talked about it and the more she talked about it ambiguous loss, the more I felt it fit the experience of many of my patients. And the more I thought about it, the more I read about it, and I have to say Pauline Boss, I really want to give her credit because she really developed a concept back in the 1970s when she was working with families of people of pilots who were missing in action.

And ambiguous loss really relates to the fact when the person looks in the mirror and I just had a patient talk about this today, who said I look in the mirror, I look the same to everybody but I’m a completely different person. And ambiguous loss confuses everybody. It confuses the person with the injury; the person looks in the mirror and says I should be just as capable of doing my job as an attorney, doing my job as a receptionist, doing my job as an artist.

When I look in the mirror I see the same person who was there before, but when I go to work I just can’t do the job the same way. And it’s confusing for people, it’s upsetting for people. I have people who go to church and the worst thing after the church service people come up to them and say you look so good, when are you going back to work? And I’ve had survivors, patients tell me that they broke down in tears when people paid them what seemed to be a compliment.

It’s just so confusing that people look one way but inside their capabilities, their emotions, their personality is so different. It’s confusing. And until people can truly recognize those differences, and it’s the person with the injury, it’s the family, it’s the people that see you in church, until people can recognize those differences, and they’re really hard to see, they’re a little bit easier to talk about, they’re hard to recognize, until people can recognize those differences it’s really hard for people with a brain injury to adjust to those changes.

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