I feel like I'm grieving my loved one who lives with mental illness. What can I do?

Note: This article provides an overview of ambiguous loss and related coping strategies based on the work of Dr. Pauline Boss, PhD, and Jerri Niebaum Clark. Resources for learning more about their work are included below.

Why does it feel like I'm grieving my loved one?

Grief shows up in all kinds of ways, and it looks different for everyone.

If you love someone who lives with serious mental illness, you might feel like nobody understands the type of grief you’re experiencing. Maybe you've asked yourself, “My loved one is still here. I can see them and talk to them, so why do I feel like I’ve lost them?”

If you have ever asked yourself that question, you may be experiencing ambiguous loss. The term “ambiguous loss” was coined by Pauline Boss, Ph.D., Professor Emeritus at the University of Minnesota. It describes a loss that comes with confusing and overwhelming emotions, lacks clarity or resolution, and often goes unnoticed.

Ambiguous loss applies to situations where someone is physically present by psychologically absent. Symptoms of mental illness can drastically change someone’s personality, behavior, and relationships. Family and friends often feel like they lost the person their loved one was, suddenly and without warning. Loving someone who is still here but whose life has been changed by mental illness brings sadness, anger, gratitude, guilt, and hope all at once. It's a complex and unique grief experience.

Ambiguous loss can also affect people when their loved one is psychologically present but physically absent: situations like missing persons, incarceration, or sudden death that are unexplainable or unresolvable (e.g., suicide, terrorism). Some family members and caregivers of people living with mental illness experience both of these types of losses at once.

If reading about ambiguous loss helped put a name to the complex feelings of grief you’ve been having, you are not alone. Unacknowledged grief can build up over time, causing distress, overwhelm, and relationship conflict. Continue reading to learn about steps you can take to navigate grief and ambiguous loss as a family member or caregiver of a loved one with serious mental illness.

How can I cope with this grief?

The Treatment Advocacy Center’s Ambiguous Loss webpage provides an overview of ambiguous loss and recommends six strategies for coping with the grief that comes with it.

Find meaning. Name your experience with ambiguous loss and explore what that loss means – and doesn’t mean – for you and your loved one’s lives.
Adjust mastery. Instead of wishing away your complex feelings of grief, learn to focus your energy on what you can control and what empowers you to keep going.
Reconstruct identity. When old relationships, behaviors, and expectations no longer fit the new version of your family and life, find new ways to meet the needs of yourself, your family, and your community. Consider what new rituals, experiences, and ways of being with others, including your loved one, might help you do that.
Revise attachment. Instead of holding on to a past version of reality, learn to “let go” and accept the parts of life that are imperfect and difficult. This doesn’t mean things are the way you want them to be; it just means that you learn to accept them as they are, so you can focus your energy on what’s important.
Normalize ambivalence. Ambiguous loss is all about mixed emotions – frustration, fear, guilt, gratitude, purpose – you can normalize ambivalence by learning to sit with all of these feelings instead of reacting to them in ways that make you feel worse.
Find new hope. Hope now might look different than hope before your life was changed by mental illness, but new opportunities for hope still come up every day. Learn to embrace the wonder and joy that is possible in each new moment.

The Treatment Advocacy Center offers an ambiguous loss support group. Attendees talk about how to cope with the complex grief that can come when serious mental illness affects a family. The training is offered in a limited cohort group with whom you may exchange support and ideas for staying well. You can contact Treatment Advocacy Center at advocacy@tac.org for more information.

Here are some other tips for working through grief as a family member or caregiver:

Talk about your loved one with others. If you have supportive people in your life, consider telling them about moments in your loved one’s life that made you happy and proud, both before and after mental illness came into the picture.
Savor time together. If it’s possible for you and your family, savor time with your loved one when and how you can. Accept that this time may look and feel different than it did in the past, but it is still time well spent.
Engage in practices, rituals, or routines. Try doing things that help you stay connected to yourself, your loved one, and the world around you. Religious or spiritual practices like prayer, meditation, or visiting a place of worship are a few examples. This also looks like keeping up with family traditions like eating a special meal or watching a special movie on your loved one’s birthday each year.
Attend a support group. It helps to connect with and learn from people who have been in your shoes – people who really get it.
NAMI Family Support Group is a peer-led support group for any adult with a loved one who has experienced symptoms of a mental health condition. By attending a NAMI Family Support Group, you can gain insight from the challenges and successes of others facing similar experiences. Contact your local NAMI Affiliate to find a NAMI Family Support Group near you.
The CURESZ Foundation "Friendsz" Caregivers Mentoring Program is a network of family members and close friends of people who have schizophrenia. They are available to offer encouragement, friendship, and support on your journey as a family member or caregiver. The CURESZ Foundation also offers a weekly support group where family members of loved ones at any stage of their recovery journey can ask questions and get support.
Talk to a mental health professional. Mental illness takes a toll on many families. Getting treatment from a trained professional can help, especially if grief and other emotions get in the way of being safe, maintaining healthy relationships, or taking care of yourself and your responsibilities.
Take care of yourself. Self-care is what helps people keep going when grief makes life hard. Consider reading NAMI HelpLine’s Knowledge Article, “What can I do to take care of myself as a caregiver of a loved one living with mental illness?” for creative and practical ideas to help you care for yourself as the family member or caregiver of a loved one who lives with mental illness.

How can I learn more about ambiguous loss?

Consider reading the following publications on ambiguous loss:

Ambiguous Loss: Learning to Live with Unresolved Grief, Pauline Boss, PhD, Harvard University Press, 2000
Gone But Not Gone, Jerri Niebaum Clark, Sager Group LLC, 2026

We are so glad you found this information. NAMI HelpLine offers a Family Caregiver Service. It brings together family caregivers with shared experiences and equips HelpLine Specialists with knowledge and insights into what helps. If you are a family caregiver and would like support from a peer, we encourage you to call the NAMI Family Caregiver HelpLine at 800-950-NAMI (6264) or send a text to 62640. We are available Monday through Friday, from 10:00 am to 10:00 pm EST.

Hours of operation: Monday-Friday, 10 a.m. – 10 p.m. EST

Call: 800-950-NAMI (6264)

Text: 62640

Email: helpline@nami.org

Website: www.nami.org/help