Maternal wounds & attachment

How Do You Grieve a Mother Who Is Still Alive?

By Dr. Donetta D. Quinones, PhD, LMHC, LPC  ·  9 min read

She has been standing in the card aisle for nine minutes. She came in for shampoo.

The aisle is organized by occasion, with plastic tabs telling you what you’re allowed to feel. Birthday. New Baby. Sympathy. Hers has watercolor birch trees and With Deepest Sympathy in a font imitating the handwriting of a very calm person.

Nobody died. Her mother is alive, eleven miles away, with strong opinions about a neighbour’s fence.

What undoes her is how much else the aisle has. A card for a coworker leaving a job. A card for a dog, and one of them plays a song. Several hundred human experiences, priced and shelved, and not one is hers.

She puts the birch trees back. She buys the shampoo.

The question nobody has a form for

How do you grieve a mother who is still alive? Or, harder: how do you grieve a thing that never happened? Not a person. A search party that was never sent.

That is the actual loss for a great many people. Not a death — a non-occurrence. No date, no body, no service, no casserole. No ritual, and no permission to mourn. So an enormous number of people carry a real bereavement nobody has agreed is a bereavement. Including them. Especially them.

Go slowly here. Not because it is sad, but because it hands you permission, and permission arriving thirty years late does not arrive quietly. This goes better with a person in the room than alone at one in the morning.

It has a name

Pauline Boss named it. She published the framework in 1999 in Ambiguous Loss and expanded it in 2006 in Loss, Trauma, and Resilience.

Ambiguous loss is loss without verification: one you cannot confirm, cannot resolve, and cannot get anybody to sign off on. There are two types. Type One is physically absent, psychologically present — the missing person, the unconfirmed death.

Type Two is physically present, psychologically absent. This is the one. Dementia, the mother whose face you know and whose eyes go past you. Addiction, which puts a stranger in your parent’s clothes for a week or a decade. Traumatic brain injury. The woman on the couch with the curtains closed while her nine-year-old makes dinner.

A mother in the next room who cannot be reached.

Boss is precise about what this loss lacks. No verification. No closure — hold that word. No consensus, because a death produces agreement and this produces people who say but your mother’s right there. No ritual, nothing for your hands. No flowers, because nobody sends flowers to the daughter of a living mother.

Take those away and you have not made a grief smaller. You have made it homeless.

Why you have never told anyone

Kenneth Doka’s term is disenfranchised grief — grief that cannot be openly acknowledged, socially validated, or publicly supported. The 2002 collection he edited names five ways a grief gets disqualified: the relationship isn’t recognized; the loss isn’t recognized, because nobody died; the griever isn’t recognized, which covers the eldest daughter who spent the funeral in the kitchen managing platters; the circumstances, because some losses embarrass a community; and the way she grieves, since not crying makes you cold and crying in year three makes you indulgent.

Nobody brings that daughter a chair; she brings the chairs. That is not somebody bad at grieving. That is somebody never issued a permit.

Why it keeps coming back

In 1962 Simon Olshansky described something in parents of children with severe disabilities that his era had no word for. Their grief was not an event that happens and resolves. It came back at each milestone. He called it chronic sorrow.

At your wedding, when you looked at the front row. When your child was born and somebody said your mother must be so excited and you produced a face. And again at her funeral, where you’ll cry and not know which loss you’re crying about. Same loss, twelve arrivals. A re-trigger, not a relapse.

Bruce and Schultz added the companion idea in a 2001 book: nonfinite loss, where what’s lost is a future that never arrived rather than an object that disappeared. So you aren’t, primarily, mourning a woman. You’re mourning the person you’d have been if somebody had come. She isn’t dead; she never existed. There is no morning on which you finish that. It isn’t a defect in your grieving. It’s a property of the loss.

The staircase does not exist

Denial, anger, bargaining, depression, acceptance. Here is what they actually are.

Elisabeth Kübler-Ross published On Death and Dying in 1969 after sitting with roughly two hundred terminally ill patients, in an era when nobody did. But look at what she studied: dying people, on their own deaths. Not survivors. Applying the stages to those left behind was somebody else’s extrapolation.

In 2007 Paul Maciejewski and colleagues ran the closest thing to a test, in JAMA: the Yale Bereavement Study, 233 bereaved people, one to twenty-four months out. The indicators did peak in roughly the predicted order — the part everyone quotes. Here is the part nobody quotes. Acceptance was the most-endorsed item at every time point measured.

A decade later Margaret Stroebe, Henk Schut and Boerner wrote in OMEGA — Journal of Death and Dying that there is “little to support the sequential development of these in stages,” citing trajectory research: about eleven percent of bereaved people follow the classic distress-then-recovery pattern, and roughly forty-six percent show stable low distress throughout.

You are not failing to progress through a sequence. The sequence does not exist.

And there was never a door

Boss’s other argument — with Carnes in a 2012 paper in Family Process, then at book length in 2021 under nearly the same title — is that closure is a myth. Not that closure is hard. That it is not a thing.

We borrowed the word from real estate and litigation and sold it to bereaved people, who have been trying to buy it ever since. It turns carrying something permanently into a failure to finish a task. What Boss proposes instead is meaning, and an increased tolerance for ambiguity — which sounds like a consolation prize until you see what it asks. Hold two contradictory truths in one hand and put neither down. My mother did the best she could, and I was profoundly alone. Both, at once, without a verdict.

You have spent years failing to reach a destination that was never on the map.

The diagnosis, and what’s wrong with it

Grief did recently become an official condition. The ICD-11, released in 2018, includes prolonged grief disorder at a minimum of six months; the DSM-5-TR added it in 2022, at twelve months for adults plus at least three of eight accessory symptoms. For prevalence, the best figure I have is a 2024 study by Treml and colleagues in Frontiers in Psychiatry, applying both criteria sets to one German bereaved sample of 1,062: 4.7 percent under DSM-5-TR, 5.4 under strict ICD-11, 6.8 under ICD-11 at six months.

Two caveats, and I mean both. That is one national sample, at one moment, not a universal rate — and the number moves with which manual you hold, which tells you how much of this is measurement rather than nature. Second, the diagnosis is contested. Serious clinicians think putting grief in the manual was a mistake: that we took loving somebody and then not having them, gave a subset of it a code number, and will end up pathologizing love. Not a foolish argument, and better heard here than later.

A diagnosis is a door, not a verdict. It opens research, treatment, trained people, a language. It has no jurisdiction over whether your love was proportionate. And these criteria are built around a death, which yours may not involve.

The grief with no task attached

Aisha is twenty-seven, a doctoral student in public health in Boston, and a composite — a pattern from clinical work, not anybody’s actual life. Eldest daughter, parentified at eight: translated documents, managed appointments, handled her mother’s moods. Everyone calls her so mature. Her internal spreadsheet of eleven people’s needs has no row for herself.

Last year she started putting herself on the list. What that produced was not insight or peace. It was grief.

It arrived at a colleague’s apartment over a pasta thing. The colleague asked her nine-year-old how the day was, the kid said “fine” and started to get up — and the mother asked a second question, about a girl at school and whether she’d sat with them at lunch. The kid sat back down and talked for four minutes about a bench, and her mother put her fork down.

“It wasn’t even a big thing,” Aisha said. “It was a follow-up question.”

The next week she arrived with a reading list, a conversation with her mother drafted in outline with anticipated objections, and two grief groups compared against her teaching schedule. She had taken a bereavement and issued herself a project plan. When I said there was nothing here to execute, she looked at me with something close to panic. “Then what am I supposed to do with it?”

Anger has a task; anger tells you who to call. Every difficult feeling Aisha has had came with an action item attached, which is how she survived a childhood that would have flattened most people. Sorrow has no task. It sits there, requiring nothing except that you not leave.

Her mother, meanwhile, is eleven minutes away and was warmer this winter than she has ever been — which Aisha found unbearable, because every warm call is proof the woman was capable of warmth. Which reopens the question the child asked at eight. Not why didn’t she love me. She never doubted she was loved.

Then where was she?

Where this frame breaks

Mothers carry this too, from the other chair; there is no funeral for a woman whose adult daughter stopped speaking to her either. The frame can also become a residence, and Boss’s goal is a tolerance for ambiguity, not a permanent address inside a category. And some of you are mourning a woman who is still available, because mourning is safer than asking — a grief conducted privately cannot be declined. That is your call. I only note that she can’t and I haven’t checked in nineteen years are different findings.

Something to do

Boss’s work points somewhere specific: naming, ritual invented where none was provided, and the capacity to hold two contradictory things at once.

Every society has machinery for a death, because grief is unmanageable without something to do with your hands — and all of it is triggered by a verified death, so none of it will start for you. Which means you build your own, and I am deliberately not telling you what it should be. A ritual somebody else designs for you is not a ritual, it is a worksheet. The invention is the mechanism. You pick the date, which needn’t be the day something happened, since for most of you nothing did. You pick who is there. And you pick when it ends, because that is what makes it a ceremony rather than a mood.

One illustration, for range and not instruction. The woman in the drugstore went back the following week, bought the birch trees, and wrote the card at her kitchen table to herself at nine years old, at an address that hasn’t been hers since 1994. She didn’t mail it, and said she’d recommend it to nobody, since it was hers.

Plainly, on the evidence: ambiguous loss is a well-developed framework with forty years behind it, and Boss’s guidelines do point toward naming and ritual. But nobody has run a controlled trial on a homemade ceremony at a kitchen table. There is no effect size for this.

The last thing

You have been waiting for permission from a world that has no category for you. It isn’t withholding it out of cruelty. It has no form to give you.

But the loss was real, and the years were real, and the child in the doorway waiting for a second question was real, and she is the only one who was ever there.

Which makes you the sole surviving witness. Witnesses don’t need permission. They need somebody to finally take the statement.