As the morning of June 24 dawned, just hours after a large portion of the Champlain Towers South condominium building in Surfside, Fla., had collapsed, more than 150 people were unaccounted for. Despite nearly around-the-clock search-and-rescue efforts for more than 10 days—apart from a brief pause while the remainder of the building was demolished for safety reasons—as of July 5, some 117 people remained missing. How do those whose loved ones are still missing cope with such devastating uncertainty?

Many are likely experiencing an emotional purgatory known as “ambiguous loss,” a state in which people have a sense of potential loss—but without the certainty that would allow them to begin grieving and recovering.

To learn more about this psychologically painful—yet surprisingly common—experience, Scientific American spoke with Pauline Boss, a professor emeritus in the department of family social science at the University of Minnesota and a clinician. Boss coined the term ambiguous loss in the 1970s and detailed it in her book Ambiguous Loss: Learning to Live with Unresolved Grief. In the discussion, she explained why the recent collapse of the Miami area building sets a textbook stage in which people are stuck in this psychological limbo, why “closure” is the wrong thing to expect, and how the pandemic put so many of us into milder forms of ambiguous loss.

[An edited transcript of the interview follows.]

How do events such as the Miami area condo collapse—in which the fate of a loved one may remain uncertain for a period of time—impact the grieving process?

When someone is missing, it freezes the grieving process—that is, you don’t have societal support to grieve. So you’re isolated, which makes it even worse.

In what way does this tragedy in Florida fit with your concept of ambiguous loss?

Sadly, it is an exact example of ambiguous loss, just as 9/11 was, just as soldiers missing in war is and kidnapped children are. Ambiguous loss is very, very common, unfortunately. And it is the most difficult kind of loss because it’s complicated by not knowing, by not having the usual facts. It’s in the gray area, the shadowland.

As time goes on, however, I’m sure that hope [of finding loved ones alive] is weakening. And that, too, is a process that is helped by facts, such as DNA evidence. After 9/11 in New York City, DNA evidence helped those who had lost loved ones a great deal.

What are some of the ramifications of ambiguous loss?

It can lead to depression and the immobilization of all of our daily processes—going to work and that kind of thing. Very often terrorists have found that kidnapping hurts the family and community more than killing people because the ambiguity is the worse torture.

But what I have found is that many of the people I have worked with over time—after a tsunami in Japan, after 9/11, and so on—find a way through to resilience, which is surprising. To live with not knowing, they shift to a “both and” kind of thinking whereby they may still keep a glimmer of hope—that someday the soldier will come walking out of the jungle or that someone will have been absent from this building in Miami and will turn up somewhere else. And they also move forward with life without that person. That takes a little time, however. Sharing a narrative, sharing your story with others who had the same kind of loss, appears to be helpful. It certainly was helpful after 9/11.

The research shows that grief does not have to end and that setting time lines has been harmful in the grief process. We learn to live with grief. That grief appears in oscillations—to and fro, in and out, up and down—but these oscillations come farther and farther apart as time goes on.

What are some other helpful ways to learn how to live with ambiguous loss that your research and practice have shown?

It is helpful to tell people what they’re experiencing is ambiguous loss, it’s the most stressful kind of loss there is, and it’s not their fault. Those are the three lines I use around the world, wherever I work with this kind of situation.

About four days after the collapse, the mayor of Surfside was still saying that he was holding out hope of finding more survivors. (Humans can typically only survive for a few days without water.) Is it helpful or harmful for people to keep hoping that their loved ones will still be found alive even when the evidence begins to mount that the worst is likely true?

It’s a balancing act at first: if there’s a reality of some people still being alive, then it’s correct for officials to say they’re holding out hope. But then there comes a time when one must say, “There probably is no one living anymore.” And it’s tough for officials to decide when that is. But families can handle the truth. And they do better over time if they hear the truth. That can help them give up the old hope—which is that this person will be found—and formulate a new hope, a new purpose. For example, that could be making sure this doesn’t happen to someone else or doing something in honor of the missing person.

We also need to be patient with these families. We want closure, but “closure” is the most cruel word that could be used. I hear it already on the news: “They need closure. They need to find the bodies.” When they find the bodies, people still won’t have closure. They will remember this person and this trauma forever. And so we’ve got to give up on that word. What we really want instead of closure is certainty: “We would like some certainty about our loved ones and where their remains are or if they’re dead or alive.” Closure is a misnomer.

How is grieving different for those whose loved one’s remains are not found?

The grief is very different. And in fact, grief therapy doesn’t work. It’s more a stress-management intervention, managing the ambiguity and managing the not knowing. It is very different from when you have an elderly grandfather who dies. That’s sad, too, but you have the facts in front of you. These people may not have it until there’s DNA evidence. And until that time, what they need to do is try to increase their tolerance for ambiguity, which is not easy because we want certainty in things. And we can do that best by using both-and thinking: “He's probably dead—and maybe not.” And so the rest of us need to have patience with people who may say, “I saw him walking in a crowded street.” That seems to happen a lot with people who have loved ones who are missing. And that’s what they do instead of grieving. They’re not ready to grieve until they know for sure.

Has the pandemic made ambiguous loss more common?

Yes. And the general public named it themselves because there were many losses—such as loss of trust in the world, a loss of being able to see their loved ones except on video calls, loss of being able to be with someone in the hospital or in a nursing home. There really was nothing we could do. We just had to learn how to live with being out of control, being surrounded by uncertainty. [Editor’s Note: Boss’s forthcoming book The Myth of Closure: Ambiguous Loss in a Time of Pandemic and Change covers this subject in more detail and will be released this fall.]

How could public officials—and the media—better handle these sorts of events in the future to reduce the harm to those who might be experiencing this type of loss?

First of all, and most importantly, do not use the word closure. It is painful for people to hear. Secondly, be patient with their reactions, which may include anger. It’s a normal outcome of not knowing. And finally, I would say educate yourself about ambiguous loss, because it’s more common than you think.