In the past two decades, trauma and psychological well-being after conflict have moved to a prominent place in narratives that address the legacies of violence, with some scholars claiming that trauma has replaced hunger as a focus of Western coverage of wars and disasters. Humanitarian assistance now routinely references psychosocial intervention, which some people claim advances both individual and societal healing after violence. Posttraumatic stress disorder (PTSD) has become the indicative diagnosis of the postconflict psychosocial intervention, considered universally applicable, despite continued contestation over its cultural specificity. This coincides with the use of human rights approaches that prioritize truth and justice and drive institutional approaches in which war crimes trials and truth commissions are perceived to provide both individual and social redress.

While working with victims of violence in two Asian states, I observed first hand how the languages of PTSD and human rights have failed to resonate with the needs of survivors of violence. I had spent years in both Nepal and Timor-Leste (East Timor) in the years following internal armed conflicts, meeting families of those who were missing or had "disappeared" following arrest. In both contexts thousands of families had seen their lives frozen in a time of conflict when they didn't know whether loved ones would come home again. In contrast to a diagnosis of PTSD, which is linked to a specific event of trauma, the anxiety expressed by families was about the missing person, rather than the event of his disappearance, and was much better understood as ambiguous loss.

Ambiguous loss occurs when a family member is psychologically present but physically absent and is an explicitly relational perspective that differs from individualized trauma approaches, such as that of PTSD, in that it characterizes the stress as external and ongoing. Ambiguous loss is a model that discusses therapeutic approaches in terms of recursive guidelines, dominated by the need to find meaning and construct new identities where these have been challenged by such loss. The model has been developed in a largely Western context, however, and the work I discuss in this article represents one of few efforts to test it in a non-Western context, predominantly comprising a discussion of the data from Nepal and emphasizing wives of the missing, for whom ambiguous loss has the greatest impact. My experience in Timor-Leste, where some individuals had been missing for 30 years, shows that even in the long term only a small minority of families of the disappeared are likely to ever receive a satisfactory answer concerning the fate of their loved one. This then begs the following question: If closure will never come, what should families do? The approach of the ambiguous-loss model is to seek meaning despite the absence of information and ongoing ambiguity and to find ways to live well despite not knowing.

Much of the need for an answer concerning the disappeared appears to be an attempt to give meaning to the ambiguity of loss and understand its implications for personal identity. A solution to ambiguity is invariably seen as being an "answer," something that would bring closure and confirm a woman's identity as a wife or widow. In the absence of such an answer, meaning is constructed relationally and is best achieved through interaction with others in the same position: wives of the disappeared (most of those missing are men) found most value in talking with other wives rather than within the family, given that many challenges result from power structures within families. The greatest problems arise when a woman's view of her identity conflicts with that of the family or community members who consider her a widow who must behave and dress as such, even though the wife is unable to admit the death of her husband as long as there is no evidence for it. For most wives of the disappeared the intentional reconstruction of identity takes place largely through contacts with other wives of the disappeared, using narrative methods analogous to those used in family therapy. In Nepal, ambiguity arises not only over the fate of the disappeared but also over the relationship of the wife to the patrilocal family. Ambivalence can thus arise both in attitudes toward the disappeared and in the conflicted feelings of family member towards the wife. Normalizing ambiguity and the resulting ambivalence primarily means acknowledging it: Resilience comes from recognizing ambivalent feelings and managing them.

Learning to live with the ambiguous loss of a close attachment requires that one revise that attachment. A number of families and communities construct tributes that are a way both of revising attachment and normalizing the ambivalence that families felt: In a culture where convention makes formal death rituals impossible, such memorials are one of the few ways this can be done. Families in Nepal are being supported to conduct traditional prayer ceremonies, and build commemorative roadside resting places and hand pumps. This normalizes ambiguity, both honoring the missing and allowing hope for their return to remain, while supporting the integration of relatives into the community.

Hope, like almost all aspirations in Nepali and Timorese society, is relational. The families of the disappeared in Nepal used the word hope most often to refer to the return of the disappeared; although most had little hope, almost all had some. Therapeutically, the goal would appear to be not to disabuse families of such hope, however unrealistic that hope may be, but to ensure that they are also sustained by other hopes. Because of the extreme poverty and hardship many live in, families expressed hopes that their children would be well fed and would be able to study, often accompanied by demands for compensation or relief payments; others had hopes that their children would be able to support them in their old age. The greatest barrier to realistic hopes was an obsession with closure, with searching for the disappeared above all else.

Because the understanding of disappearance is constructed socially within family and community, its impact must be understood in the same terms, and interventions should be initiated at the multiple levels of individual, family, and community. What also emerges is that many individuals and families have been able to live well despite ambiguity by finding locally relevant ways to reconstruct meaning and identity. Those who have coped least well have become fixated with the ambiguity of their loss and obsessed with seeking closure. Human rights interventions with families of the missing have habitually emphasized issues of "truth and justice." Such interventions, driven by a search for—and implicitly promising—closure, focus attention on ending ambiguity, rather than living well despite it, and can of themselves construct meanings that are both negative and that encourage the worst types of coping. Such emphases militate against a coming to terms with ambiguity and, at their worst, can serve to valorize the trauma of ambiguity when closing emotional wounds is perceived as betraying the missing. The data suggest that interventions with families of the missing that emphasize truth over all other aspects can be potentially damaging by reinforcing such negative coping.

Interventions with families of the missing in Nepal suggest that the lens of ambiguous loss is effective in understanding and addressing the impacts of unresolved loss, even in contexts very different from the North American one in which it was developed. In contrast to PTSD, ambiguous loss emphasizes the relational and uses narrative approaches that are immersed in local cultures, demonstrating the possibility of an approach to well-being after violations of human rights that is relevant for the very particular experience of families of the missing.

Suggested Reading

Boss, P. (2006). Loss, trauma and resilience: Therapeutic work with ambiguous loss. New York, NY: W. W. Norton.

Robins, S. (2013). Families of the missing: A test for contemporary approaches to transitional justice. New York, NY: Routledge Glasshouse.

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