Around 155,000 individuals go missing annually in the United Kingdom, devastatingly impacting their loved ones and communities. When we realise that each missing person has a direct emotional and financial impact on twelve people in their close circle and community, the scale of the problem becomes apparent. 

Indeed, the emotional and financial strain of having a missing person in the family can take a toll on the mental health of those left behind. Relationship breakdown, mental illness, anxiety, depression, and dementia are some leading causes of missing people in the UK. What is worrying in this cost-of-living crisis is that 1 in 50 people go missing because of financial problems. It is a significant public health issue that needs more attention. 

Since many professionals and the public are unaware of these difficulties, this throws the responsibility of explaining to already suffering individuals; doing so risks having their story disbelieved, leaving them without adequate support. 

My mum, who had Alzheimer's, went missing in France in 2013. She was unfortunately never found. This left lasting wounds that we are still trying to heal 10 years on. Getting support after years of struggles helped, but many families don't ask for help. This is where you can make a difference by understanding the unique experience they are going through and supporting them the best you can. 

Therefore, I am sharing the research results I conducted in the second half of 2022 with relatives of missing people with the help of the charity Missing People. This art-based qualitative research project aimed to examine the relatives' experiences of missing people, focusing on ambiguous loss and moral injury. The study gathered insights from 39 participants in total that took part in either a group brainstorming workshop, collage focus groups or life story interviews. The findings are represented by:

- A  8 mins animation depicting all findings from the literature review to the themes, support themes and stories.

- Themes with quotes and narrative representations from participants, illustrated using animated and augmented reality paintings and participants' collages. 

- A mind map of the current needs of the participants

- A  personal story relating the lived experience embodiment through a 3 mins film.

- Two case studies.

If you are using any of these resources or any material on this site, please cite as:

Waschnig P. (2022, December). Through the prism of missing: Moral Injury - Understanding the Needs of Relatives of Missing People  https://www.pascalepsychology.site/Missing-people, UWL

Creative writing: And I yelled, Aline, for her to come back

“I remember us singing along, giggling as kids, listening to my Mum’s favourite song from the ’60s, shouting Aline playfully to the top of our lungs in the warm kitchen filled with the wonderful smell of heartful, comforting dishes my Mum was baking… you see, my Mum was a strong woman and a sweet soul. Food was her language, her lyrics were sweet like honey, love-full, warm-full …  

I remember her feeling so special to have a love song named after her, smiling, listening to us, and joining in...  

Little did we know that this song would become her reality, our reality, the lyrics depicting her fate as she went missing during a rainy month of May nine years ago, near rivers she might have fallen into… “

Translation of Aline song, Christophe, 1965 (Christophe, 2012)

I had drawn on the sand
her sweet face smiling at me
then it rained on this beach                                          

she disappeared in this storm
And I yelled, yelled, Aline, for her to come back
And I cried, cried, oh! I had too much sorrow.
I sat down next to her soul, but the lovely lady had gone away
I searched for her without believing it anymore
and without a hope to guide me
And I yelled, yelled, Aline, for her to come back
And I cried, cried, oh! I had too much sorrow.
I've only kept this sweet face
like a shipwreck on the wet sand.

“I remember the dark veil of bewilderment, closing like a heavy stage drape before our eyes as my brother and I listened to that song we had not heard for years on the radio while preparing to search for my Mum…the visceral pain, the absurdity of life sung before us.. telling us that her story had already been written and that we might not be able to change the denouement despite all…but that despite all we will never give up hope to find her…. 

The absurdity of life… reminiscent of the myth of Sisyphus and Victor Frenkel. How to find meaning in the very midst of the desert, a way out of despair? 

As we were shouting Aline like cubs calling their Mum for protection because they would not be able to survive alone in the wildness without her, we were shouting maman “Aline” at the top of our lungs because she would not be able to survive alone in the wildness without us…

Little did we know that the trauma of searching for her would still be as vivid today as nine years ago as we never found her... “ (Waschnig, 2022).

Public health concern

Research shows that people go missing on a continuum from intentionally (i.e., relationship breakdown, distress, sometimes perceived as social suicide (Bennett & Ferguson, 2022; Stewart, 2020) to unintentionally (i.e., diagnosed, or undiagnosed mental health, four in ten people living with dementia go missing) or as a criminal act (human trafficking, sexual exploitation). Among individuals experiencing mental distress, the incidence of repeatedly going missing is high. One in fifty missing adults’ disappearance is due to financial problems (Missing People, 2022). ‘Missingness’ (Finkelhor et al., 1990) might be attributed (i.e., the person is unaware of their missing status), which implies complex relational issues (Parr & Fyfe, 2013). A recent study found that missingness is rooted in maladaptive coping techniques (Huey & Ferguson, 2022).

Missing as investigation

Lack of investigative leads and police practices can lead to ‘cold’ or ‘long-term’ cases in missing person situations. Regulatory and legislative frameworks, the policing system, public policies, procedures, and risk evaluations vary worldwide (Bennett & Ferguson, 2022).

In the UK police evaluate risk, search, and protect. Sharing the duty of care with other agencies (social services, health and education) needs to be more adequately defined. This might cause conflicts and a lack of frameworks, increasing the incidence of missing children in care and mental health facilities (Kotecha S, 2022; Missing People, 2020; O’Brien et al., 2021).

Police risk assessments highlight a missing person's vulnerability, risk of damage to self and others, and necessary resources and ways to find them. They rely on the quality of information from families, health and social care professionals, and police officers’ professional curiosity and are consequently subjective (Hayden & Shalev-Greene, 2018).

Missingness carries a stigma, and police and the public typically see families as possible culprits (Parr & Stevenson, 2014; Siddiqui & Wayland, 2022). This amplifies the anguish of the unexpected loss, contact with authorities, the traumatic and never-ending search, and the lack of knowledge about their loved ones, where they are, and what to do (Testoni et al., 2020a).

Media coverage

There are variances in media coverage while seeking missing individuals, however, witnesses are vital to solving cases quickly to locate that person. The missing person's newsworthiness, age, social status, beauty, body size, criminal background, race and gender lead to overrepresentation in the news of middle-class young missing women portrayed as innocent (Liebler, 2010; Slakoff & Fradella, 2019). Although charities like Missing People are supporting families in publicising missing people in the media and through guidance material (Missing People, 2022), and police forces are using emotional arousal in social media communication to increase valence in citizen participation and public perceptions of missingness (Leppert et al., 2022; Solymosi et al., 2021), many families of missing people face the Missing White Woman Syndrome.  

Families left behind

When a family member disappears, many are speechless. It's difficult, if not impossible, to describe such an experience. Beyond a storyline standard schema, relatives have no vocabulary, ritual or set of behaviours to resort to, leaving them feeling lost (Boss, 2000, 2007, 2017; Boss & Carnes, 2012; Wayland et al., 2016a; Wayland & Maple, 2020a; Wayland & Australian Federal Police, 2007). In narrative terms, there is chaos, a narrative void and the feeling of living suspended in emotional limbo. The experience of sudden and repeated trauma in relatives of missing people (Kennedy et al., 2019) substantially impacts the autobiographic self (Clifford et al., 2020) as the expected trajectory of a person’s life is disrupted. Lives, interrupted by the “turning point” of a relative going missing, often involve considerable alterations in cognitive schemas, narratives, identities and life trajectories (White et al., 1990). Understandably this can have an intense, long-lasting impact on mental health and the ability to seek help (Kennedy et al., 2019; Lenferink, Eisma, et al., 2017; Lenferink et al., 2018, 2019; Lenferink, van Denderen, et al., 2017; Missing People, 2019). Additionally, the effects cascade leading to one Australian study suggesting each missing person will impact on average twelve persons (Wayland & Maple, 2020a).

The aftermath of a disappearance is emotionally draining and distressing. Loss, powerlessness, bewilderment, and guilt are ambiguous experiences (Parr et al., 2016). Families are left with no time and often no knowledge of how best to deploy search strategies. The new liminal landscape they inhabit exacerbates the abyss of uncertainty.  In such situations family members often lose their sense of self. Liminality reduces temporal and spatial ontological security and comfort (Jellema et al., 2021). Their sense of agency, life trajectory, expectations and narrative map are disrupted, thus they must be renegotiated as they are no longer informed by past experiences (Hartonen et al., 2021).

In the waiting, they need to create new parallel temporal regimes where living with uncertainty might become permanent as time progresses (Katz & Shalev Greene, 2021).

The painful impacts of loss are amplified by legal, social, economic and administrative problems, everyday commitments, and dysfunctional family relationships, such as misunderstandings and reciprocal blame (ICRC, 2014). All these challenges might prohibit families from reconstructing after an absence for years (People, 2011).

Theorising loss

Ambiguous loss is the theoretical framework for the relatives of missing people (Boss, 2000, 2007, 2017). Living in a liminal space, their loved ones are both present psychologically and absent physically (Davies, 2020; Wayland et al., 2016a; Wayland & Maple, 2020b), leaving families feeling estranged from their lives and connections. Families are left in limbo by the absence and lack of resolution, alternating between optimism and sorrow. Their loss is interminable: disenfranchised grief worsened by anticipatory mourning (Testoni et al., 2020b).  Helplessness and uncertainty exacerbate the family's inability to move on (Wayland & Maple, 2020b). Stress, anxiety, intense sadness, a sense of loss of control, and avoidance are normal reactions, but constantly reflecting on what might have happened traumatises families and prolongs grief. Non-referent upward counterfactuals were a significant predictor of prolonged grief, while self-referent upward counterfactuals also predicted psychological suffering (Lenferink, de Keijser, Piersma, et al., 2018; Wayland et al., 2016b; Wayland & Maple, 2020b). Closure-seeking is an unhelpful coping strategy. 

The prospect of locating the lost individual is both a beneficial and damaging coping approach, say Wayland and Maple (2020). Supporting families to cultivate the missing person's memory (Parr & Stevenson, 2015) and exploring ways to process and express the loss in the family nucleus and community are crucial (Wayland et al., 2016a). 

When the cause of the disappearance is unknown, guilt, rumination and counterfactual thinking are common coping mechanisms. The absence of a loved one is an ‘ambiguous loss’ that may increase the likelihood of prolonged grief (PG)[1], depression, and post-traumatic stress (PTS) symptoms (Kennedy et al., 2019a; Lenferink, de Keijser, Piersma, et al., 2018; Smid et al., 2020).

[1] PG, also known as complicated grief or persistent complex bereavement disorder, is distinguished from normal grieving by its higher intensity and longer length. It is marked by profound sadness and longing for the departed.

The research received the University of West London's ethical approval. 

The rationale for using a social constructionism paradigm to underpin this research: It encourages the study of the phenomenon in context, with the researcher relationally involved in the study, to illuminate the constructed nature of social reality and reality itself as an ongoing construct in the formation of knowledge (Aburn et al., 2020; Berger & Luckmann, 2016; Crossley, 2000; Mcintosh & Wright, 2018).

Why use Art-based methodologies? 

Art-based methodologies offer a unique opportunity to reach a diverse audience (Leavy, 2020) to provide engaging accounts of the experience of families. Previous research (Igartua & Frutos, 2017) has demonstrated that contact between members of an ingroup and of an outgroup through storylines in movies or television can lessen antagonism. Furthermore, identification with members of an outgroup performs a vital moderating role. 

Enhancing introspection, empathy, observation, and communication abilities is posited as a potential outcome of engaging with art (A. Smith et al., 2021). Indeed, vicarious experience allows for a deeper examination of the human condition and an awareness of other perspectives on various social and psychological concerns (Barone & Eisner, 2012), “blurring the Self-Other divide” (Douglas & Carless, 2013). 

Art-based approaches (and their outputs) can also help access what participants hold in their bodies yet find difficult or impossible to communicate with words alone (Leavy, 2020; McLeod, 1997). Tripp et al. (2019) describe Art-based research as a route through the impasse of silence. 

In addition, neuro-aesthetics research (Mastandrea et al., 2019) suggests that aesthetic pleasure emanates from emotion processing involving top-down processes and reward areas in the brain. Experiencing art can be seen as self-rewarding, irrespective of the content of the art or art form. Research has shown that an art context increases positive responses, emotional state and pleasure towards images even with negative content. In an increasingly visual world, using narrative texts and visual narratives allows multiple forms of media, semiotics, metalanguage, narrative imagination and visual grammar to expound shades of embodied meaning (Andrews, 2007; Williams, 2019). This suggests that representing findings through Art-based methodology has the potential to engage more empathetic and positive responses.

Multiple methods: Given that experiences are embodied knowledge, and not all knowledge can be narrated, this research used various data collection methods to fully support participants in sharing their experiences. 

Participants: Families or close acquaintances of a missing individual were selected, according to the UK College of Policing (UK College of Policing, 2022).

Challenges

        For many of the participants there was a sense of rupture within; where the world that was known becomes dangerous as explored in research. As Marion and Jessie said: “You've got to think the worst of everybody in every situation.”  “Nothing can prepare you for it”;  the experience of missing  “It's not something you expect to ever happen in your family.”

Consequently, the families feel like “Everything has just lost its ground and bearing”. Coupled with that rupture, there is also a lack of control: capturing this point Jo said “...from your life exploding to being overwhelmed.” like witnessing cascading events you cannot control.

One issue tied to the rupture and loss of control evident in many stories and artworks was the effect of not knowing what happened to a loved one, described as “Not knowing is the Killer”. They are left in a never world where all scenarios are imagined and thought repeatedly. Often, because the authorities are not conducting the investigation properly (Moral Injury–Betrayal), the families must run their own investigation as Marion and Lesley share: “You have to open all doors”, “There is absolutely nothing that anyone can tell us that we haven't already thought of”.

The lack of control, rupture and not knowing forces relatives to renegotiate who they were and is often recognised as a failure of the self, expressed here by Lesley: “I'm the one that sort of fixes things for everybody… It is quite painful not to be able to fix it… it’s the helplessness.”

The pain never leaves or diminishes; the narrative of the collage (Figure 8: Missing) seeks to highlight the vulnerability and entrapment of the self, left without memories, futures to be told or exit to the agony.

It leaves a void that the relatives can only fill with imagined scenarios (see Figure 6: “It is always with you”).  The emotional roller-coaster and mental torture of uncertainty forever transform their existence “Constantly descending into darkness without ever reaching the bottom... You just keep circling around… Anxiety, depression, and cycle of hoping and despairing, and it just feels overwhelming… I just don't know any way to navigate through it psychologically.” “Post-traumatic stress disorder, post bereavement counselling, post this, [post that].  The problem is, it's never blooming post anything.”

Their life is suspended in limbo, waiting for news, powerless; see Figure 7: The void in us.

Jo used the shredded poster of their loved one to represent the rupture of reality that the missing incident meant, “like an explosion” with stray bullets shot in the direction of the person drowning with their possessions (life, family, inner strengths) safely held above the water, this powerful, uncontrolled force of nature (The world as a dangerous place, lack of control).

There is a sense of loneliness (feeling alone) in the experience, of immobility (limbo, not knowing, endless waiting, living with uncertainty), of not being able to put one foot in front of the other in those waters (sense of rupture within, world as an unknown place) that the animation and sound effects accentuate.

The shredded search poster represents the entangled, disorganised, conflicting emotions (emotional roller-coaster) associated with the trauma of the search, amassed in a disordered manner above the overbearing word missing. This label now defines the missing person and family (isolating experience).

Help is a “slow-moving boat” (restoring agency), taking them back to the journey of life or death but not away from the explosion (keep circling). It is also represented as a weapon, “a double-edged sword”, the symbol of power, protection, strength and courage that can turn itself against them too.

The trapped emotions go in a circle “like an unrelenting broken record” without exit because they are without new clues (keep circling around). You can only go back to your wounds, hide, and relive the trauma and “agony” of your new life (living with uncertainty).

In Figure 8 (below), we see the themes of renegotiation of the self and the world around, the realisation of the fragility of life, that the forces of nature, of life, are more vital than human endeavour “no amount of strength”, than the human effort “searching”, it is uncontrollable; “collapses” like “dominoes”.

This realisation of not being in control (lack of control) of the missing event requires the families of missing people to renegotiate their approach to life (renegotiating agency, adaptation) through the lenses of ambiguous loss, to give into uncertainty, even if it is not without a fight (conducting your own investigation).

The lack of social support from the community around them leaves wounds that are hard to address. This represents an isolating experience that feels like a label, a new identity. Systemic types of marginalisation or lack of social support inhibit self-renegotiation, in the absence of the missing person (Figure 9: Feeling alone). Participants share that it is difficult to talk with their family. Jessie tells us: “I've got my brother I find it impossible to talk about anything”.  For Alex, it is difficult: “If I get upset, they will say: oh come on then change the subject and I'll say NOO... I want to talk about it.”  But you can’t talk to other people either; “people don’t understand”, Darcy explains.

As the number of witnesses diminishes, families have the suspicion that others are not always as well-intentioned as they might have believed; “We trusted way too much. We trusted the people. We lived around way too much. We didn't know at the time these things were happening”, Carol explains. As the investigation progresses, there is the feeling that “Somebody out there must know” as all participants share. This  is very destressing as it is seen here by Carol as a condemnation to unending limbo, not to be able to provide a resting place for the missing person: “I have been cheated of knowing where he is and burying him.”

This sense that others don’t care is exacerbated by the malicious behaviour of Cyberbullying, people profiting from the distress of others, that is seen here by Darcy as “… mentally difficult, really sick issues out there with people”. Children do suffer from bullying “ they picked on [the sibling] one day, saying to him… , what do you call fish bait? [the missing person’s name].  Of course, he lost it and he went for them and got into trouble.”

They are also affected in silence (see Figure 12: Children left behind).  “There isn't a day that goes by that I don't think of xxx”.  Despite the best efforts from their parents, it is difficult to prevent them from compensating for the missing sibling: “We both had conversations with them: Don't try and make up for us not having xxx.”

Being at the service's mercy

This moral injury is probably the biggest struggle that all participants shared. The sense that police forces are not only ill-prepared to conduct investigations but also not showing the expected professional curiosity “It was chuffing hopeless. The police were literally way worse than useless because they took an awfully traumatic situation and turned it into something worse” (Figure 13: Constantly filling the gaps).

Families know that there are inequalities in police resource allocation, as Carol shares: “Some long-term missing person investigations receive significant police resources, whereas others receive much less”.

Across all participants, frustration was high as the police had not listened to their advice and knowledge of the missing person (not being heard). This pushes families to conduct their own investigation, which can be traumatising as the families are then exposed to facts that might be disturbing; “because you have no one else to rely on, you try to do it yourself.”

Figure 15 depicts the loneliness (alone against all) free fall into the muddy world of missing, where the motives for the disappearance of the loved one must be “pieced together” (restoring agency). Here Marion expressed in her collage the moral injury and violation of trust from organisations she was meant to trust, and from others unable to help solve the mystery of the disappearance. This inevitably leads to the omnipresence of a person in the mind of the relatives.

Being seen as a potential perpetrator by the police can destabilise and flip the world around them upside down: “I didn't know it was possible to be so angry. So they could stop wasting their time [on me] and then look for [the missing child] instead… so I hung myself on the balustrade tops.”

Temporality

In this theme we see that participants go through a process of moral reorientation.  Children help the return to normality, Darcy thinks “We have moved on partly because of the children, because of the routine of life.” Friends and family are helpful “to deflect” as Carol shares.

Over time, participants have become better at controlling and containing emotions. Lesley explains: “I bring myself down and deal with my emotions after I get back [from press interviews]… in short segments.” For Darcy it is more engrained: “Maybe, I've sort of hardened myself up a bit inside.”

            Hope is omnipresent and often seen as what keeps the families searching. Lesley explains: “Grieving is giving up on her”, “Until she is found, I will be still mentally looking until she is found.” Hope takes different forms.

However, over time, we see that hope changes, and each transition comes as a loss, where the meaning of hope is renegotiated:

1. Hope is a driving force families lean on:  “Regardless of how much hope we've lost, we will still never give up searching” Marion is convinced of this.

2. Doubts about finding the missing person emerge. “You always want to hope the person that's missing is alive, and even if you're never going to see them again, you always want to hope that they're somehow living a good life.”  

3. Giving up on hope to make a difference. “I've sort of given up hope that I'm going to get any further on with my investigation” and that the police will help: “Having to accept that the police can no longer help.”

4. Hope to “ know what happened” to find answers.

5. “Hope to draw a line under it: “Ideally, like his body to be found just so we can grieve over.” This can also inflict moral injury to the self.

Over time, the anger and moral injury experienced by participants are replaced by resignation “I've done a lot of anger there [against the police], mostly now it's just despair ” Jo shares; for others like Darcy it is acceptance of what you can’t change “If you like, for want of a better word, cause the police won't do anything unless I find some new information… they say they can't, and I have to accept that.” 

With the passage of time, the process of restoring agency in oneself seems easier: “It’s become more liveable, part of the fabric of our lives.”

Conducting your own investigation allows families to take control of the situation. Lesley explains how she approaches witness accounts, “How can I analyse this? How genuine does this feel? I look at probability factors of whether or not it can be a possibility…” For Carol focussing on her investigation “Sort of gave me something to act on.”

For Marion “pushing doors” is a state of being. It “becomes part of you to push yourself to, to do things you wouldn't do normally” contributing to growing from the trauma which is part of the meaning making process.

But families are aware of the disparities in the allocation of resources and demand better controls. Carol explains: “All families should have the guarantee that everything possible is being done. Greater transparency is needed.”

Families often admit they struggle to keep a hold on the memory of the person for who they were before missing.  Jessie explains: “Then [the poster picture] became this kind of iconic image that seemed to belong to everybody else… when your photograph, for the press to keep a campaign going, and then it becomes public property and not [your loved one] anymore. It's a very weird thing.”

Looking at the data, one can see that the support families can be seen as agency enabler:

•  Missing People plays a key point here for some. Carol and Darcy explains: “That's when I heard the calming voice saying, this is what we do… Like a lifeline.”, “Just the feeling of being able to talk to people that understood was as much of a help as anything.”

•  The media: Lesley thinks they are “fantastic.” The media are often stepping in helping with the investigation through programmes contributing to social justice. Darcy feels “The press are doing a lot of research, far more than anybody's ever done in the past.”         

•  The public: “absolutely amazing” from all participants

•  Therapy: “at various points in the journey, all of which have been really helpful.” (Figure 16: Hypnosis bringing us together).

As illustrated below, the experience of missing people begins with a disruption to daily life, a re-evaluation of the environment around the family, and a re-evaluation of the self as they find their sense of agency altered in a world of uncertainty. The families can eventually adjust to their new landscape by regaining their feeling of agency.  Therefore, it is not unexpected to learn from the workshop that the valuable assistance has been focused on friends and family, the media, the public and Missing People under the theme of Agency enablers. The same may be found in Renegotiating the world around and Renegotiating agency, where the police and community reaction and some family/friend assistance are considered less valuable. In terms of future help, we would want to see improved support from the police, lowland rescue, continued support from the media and Missing People, friends and family, social workers and their doctors. This highlights the importance of a dynamic social support system.

Figure 18  Cognitive map of support - Post-it contribution from participants, Brainstorming workshop, Missing People Family Day, 12 June 2022 

Moral injury

The experience of missing people’s families starts with a rupture of ordinary life and a re-evaluation of the family's environment. This is challenged as they go into a journey of renegotiation of their self-identity whilst living through moral injury and a diminished sense of agency resulting from the uncertainty of the world around them. As processes involved in reshaping identity are frequently ingrained in a person's cultural, family, and spiritual roots (Jamieson et al., 2021), we see here some participants struggling more than others with the label attached to missing or feeling of lack of control. One participant who suffered long-term psychological repercussions from this moral injury, found comfort in his religion. Indeed, research (Hall et al., 2022) found that incorporating religious or spiritual practises into established trauma-related treatments may help address moral injury. This could be extended to missingness and ambiguous loss (Boss, 2007). As the search is particularly traumatic (Parr et al., 2016), moral ruminating over actions and/or events deployed by authorities during the search that seemed wrong for the individual/families may escalate over time, in addition to family-self-related moral anguish. This might induce long-term guilt, shame, PTSD and anger (Litz et al., 2009; Molendijk, 2018).

Disenfranchised grief can cause profound behavioural, emotional, cognitive,  physiological and psychological distress (Davies, 2020; Wayland, 2015; Wayland et al., 2016c), a moral injury directed towards the self and others (Litz et al., 2009; Shay, 2014). Support systems, self-esteem,  forgiveness and belief in a "fair world" may shield families from moral harm following the disappearance. Although moral injury in this context could be considered an effect of the disappearance, guilt inherent in moral injury is thought to have its own consequences, such as demoralisation (Shay, 2014), isolation and shame, here associated with uncertainty about the unknown, often speculative or imagined reasons why someone is gone (Davies, 2020). When an inner conflict is not resolved or addressed, moral sentiments and behaviours tend to get stronger over time (Shay, 2014).

“We are what other people care about” (Lindemann, 2001)

It is not surprising to see from the post-it workshop that “less valuable support” is reflected in the themes of renegotiating the world around us and renegotiating agency, where the police, community response and some family/friends could be seen as morally injurious. Research on moral injury suggests anger and mental suffering are key outcomes(Molendijk, 2018) The relatives’ accounts expose the anger towards the different aspects of moral injury at the forefront of their embodied experience, as well as the psychological pain and fear for the life of their loved ones. The evidence gathered points to a more systemic and more profound problem that is not necessarily connected to the experiences of relatives of missing people but is instead rooted in actual or perceived cultural and moral misalignments linked to support that should consider the person's dignity.

The responses to “valuable support” come from friends and family, the media, the public and Missing People (‘communitas’ (Hartonen et al., 2021b)). Families can gradually adjust to their new surroundings by restoring their sense of autonomy/agency through self-determination. But reminders of early traumatic events occasionally interfered with regaining a steady sense of self (Jellema et al., 2021). 

The ability to cope in individuals and families is recognised by ambiguous loss theory (Boss, 2007). Coping is the capacity to accept ambiguity in the likelihood that the truth will never be known (Davies, 2020). Moral reorientation depends on a solid foundation and a feeling of belonging in a supportive social network with warm, responsive connections (Gilligan, 2000). Outside the family, protective variables include excellent role models and support. Regarding future support expressed, relatives would want improved support from the police, lowland rescue, continued support from the media and Missing People, friends and family, social workers and mental health awareness. Effective schools, connections to pro-social organisations, and vital emergency and support services are community-level requirements for establishing resilience (Davies, 2020) and trust in organisations. Mechanisms for fostering hope, the crucial element of meaning in life, are necessary for the agency (Hartonen et al., 2021b) as, over time, social support significantly and reliably decreases anxiety, depression and psychosocial issues, regulating acculturative stress and enhances psychological well-being and adaption.

The ethical dilemmas caused by institutional inaction establish a framework for exposure to potentially morally harmful events, moral distress, and moral injury (ie, functional impairment caused by moral violations) among relatives of missing people. This requires specific considerations for clinical intervention and policy initiatives.

 Early identification of missing people's families' exposure to potentially morally harmful events associated with institutions is crucial for preventing and intervening in moral injury. This is crucial as Moral injury may lead family members to believe they do not deserve to feel better or be helped, which could negatively affect how much they engage in treatments and support.

Confirmation of expression of reality from participants

(Criterion: Validation of Worthiness and contribution and Expression of reality)

Confirmation from participants when asked if the products reflected their experience and if they needed any changes:

“Brilliant job.  I have never seen anything quite like this insightful and very real commentary on the experience of ambiguous loss; it has great strength in that it draws from a number of people, whereas most of what you see produced by the media tends to focus on one individual case and only one person's emotional journey.  I think you have produced something quite unique. It really is quite brilliant how you have drawn the strands of experience together through it all.”

The animation and film:

“[They] cover so much in a clear and relevant way of personal and shared experience that I can think of nothing that would need any change.” 

Animation, collage, and paintings:

“I cannot find any fault with what you have portrayed in a very emotive way.  I cannot think of anything to improve or change.  It’s very accurately depicting this loss.”

Collages:

“Art focused group... Yes all good. All that is said is what one thinks and longs to share with people that understand.  Not always easy to do as you say, as not everyone understands or wants to talk about it.”

Paintings:

“… They definitely reflect the emotional experiences of ourselves and quite a few people I have spoken with over the years.”

“The Void.......Yes every word so apt, exactly the feelings."

Paintings – collages:

“Yes, this reflects a good deal of what families feel and good to think about children too as they are so often neglected.” 

 Story:

“Fiction?… Ah! but we know it’s NOT [a fiction], is it? Excellent story, says it all, many people’s lived experience.”

Faced with such a high incidence of missing people, governments know they must invest in prevention, address privacy concerns about CCTV facial recognition deployment, relevant data-sharing protocols between agencies and police forces, social support and multi-agencies partnerships, and public health and community-based approaches (Wayland & Ferguson, 2020). This might enhance prevention, and risk assessments, train police liaison officers, improve public health awareness such as coping skills for emotional regulation, and increase mental health support for the families and their missing loved ones. Interventions and policies should prioritise reducing moral injury, minimising stress, and promoting coping mechanisms. 

Future research should reach out to families of missing people sharing specific characteristics (e.g., frequency and cause for missing episodes, prior degree of police trust, socioeconomic and cultural background) to explore the impact and reasons for not seeking help.

Creative writing:   DNA

“The policeman tapped his pen on the counter…

“What?” he said “a DNA search on the Interpol register? What the hell is that?”

He looked down at his notebook, “Look”, he continued, “your Mum went missing NINE years ago.” “We won’t have ANYTHING in our files”, he said, “Her case is closed. We don’t have any record”    

Don’t they understand?  

For me, 

“The case” is never, ever closed 

It is 

9 years of not knowing, 

9 years of going from hope to despair, 

9 years of visceral pain that wakes you up in the middle of the night, 

9 years I want to know where she is, 

3285 days of not being able to “move on”, 

78840 hours of suffering… 

So yes, I want YOU to look for her, 

I want YOU to do something and stop wondering why I am still looking for her after so long…   

So yes, I want YOU to look if she can be found even dead

I want to be able to remember the good memories, 

I want to stop thinking of the search poster picture, 

the search dogs, 

the forests,

the sleepless nights, 

the endless days and nights I cried, ripping my heart apart 

because I didn’t save her… 

So yes, it is my RIGHT, 

I have the RIGHT to know, 

I have the RIGHT to demand your help even 9 years on…. 

I DO, Don’t I? (Waschnig, 2022)”

Raise public knowledge of ambiguous loss and moral injury to reduce apathy and enable organisations to contact marginalised communities who don't use support systems,

Exploring moral injury and the different interventions that might help undermine stigmatisation: 

a. Moral injury self/others - Renegotiating the self and the world around by fostering adaptability:

1. Accept the part of oneself that experienced harm without blaming oneself  

2. Reclaim goodness and humanity and

3. Forgive oneself - An essential step towards self-forgiveness and regaining a sense of personal worth is examining maladaptive beliefs about oneself and the world. What might be helpful here is to explore bias with clients, especially belief in a just world (impact on oneself and others), attribution bias and defensive attribution hypothesis. 

Some of the maladaptive beliefs and biases to explore:

• Belief In A Just World: Our strong bias makes us want to think that the world is fair and just and that bad things only happen to bad people who deserve them. Therefore, we blame the victim / we blame ourselves.

• Attribution Bias: We victim blame because of a cognitive flaw; we don't correctly link bad things to their causes.

• Defensive Attribution Hypothesis:  When we think the victim is very different from us in some way, like age, race, country, sexuality, or culture, we victim blame them. According to this idea, we will feel more sorry for the person and blame them less if we are more like them.

b. Moral injury betrayal/self/others - Renegotiating and fostering agency - increasing a sense of control or perceived control, intentionality, forethought, self-reactiveness (self-regulation), and self-reflectiveness (self-efficacy). Explore counterfactual thinking through narrative therapy.

c. Moral injury others: The need for systematic counselling interventions or counselling, especially for siblings and for children, but also to reduce self and mutual blame and rumination within families.

d. Moral reorientation - fostering reparation – Exploring self-blame, guilt, shame, victim’ stereotype and anger through narrative therapy - re-engagement and reconnection 

– Improve self-care 

– Consolidation of meaning

– EMDR, Hypnosis and self-hypnosis, narrative counselling, and art therapy are all valuable interventions. 

Increase support for children of relatives of missing people, 

Investment in technology, data sharing across agencies to prevent people from going missing and to aid investigations,

o  Include finding products:

o  In exhibitions to incite discussion in the press and other media  

o  In training material (2 case studies, animation, film, animated paintings and collages) for the police forces, social services, counselling organisations and charities.