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Participant Two: Karl
Karl struggled with a variety of thoughts and feelings in response to losing his daughter, Dana, from SIDS, one and a half years ago. He reported that he struggled the most with knowing that Dana died “on his watch,” and with telling his wife, Vicki, about the loss over the phone, since she was away on a business trip. The guilt that he felt can be understood by applying Leon’s (1990) model of perinatal loss to men. Leon believes that as a mother develops maternal identification during pregnancy, she becomes more prepared to engage in the care-taking role of her completely helpless infant. This maternal identification coupled with the care-taking role, however, leads to feelings of guilt and responsibility if a perinatal loss occurs. Although this theory was formulated for women, the present study applies it to men, as no theory of its kind exists for males after perinatal loss. When we apply this theory, we could hypothesize that because his baby was four months old when she died, Karl already had the opportunity, both during pregnancy and after her birth, to develop his paternal identity. Therefore, his sense of responsibility for Dana could have been developed, leading to feelings of guilt, and self- blame when she died. Moreover, Karl’s wife was away when Dana died, further exacerbating these feelings. This made Karl assume total, rather than shared, responsibility for Dana’s death.
Additional explanations from Leon’s (1990) model of perinatal grief may also apply to Karl’s struggle with his sense of guilt. Leon (1990) hypothesized that guilt could be in the service of reducing feelings of helplessness in a parent who had a reproductive loss. Given Karl’s feeling of helplessness over both “. . . not being able to do anything to make Dana better,” and not being able to comfort Vicki when he told her about the loss over the phone, it is likely that feelings of guilt helped control his overwhelming feelings of helplessness.
Karl’s increased behaviors of over-protectiveness and cautiousness when taking care of his subsequent daughter Melissa, is related to Karl’s sense of helplessness, guilt, and responsibility over Dana dying “on his watch.” Although he described taking many precautions during the pregnancy with his first daughter, he also talked about how this cautious behavior increased with the birth of his subsequent daughter. Taking precautions with Melissa may have been a way to contain and gain mastery of his feelings of helplessness described above. Another possibility is that his cautious behavior was a way to feel “more in control” of his sense of guilt over her death. Leon (1990) believes that overprotective behavior observed in a parent who suffered a reproductive loss with a previous child, may unconsciously serve to keep the subsequent child as an “infant” to undo the previous death. Although it is possible that Karl tried to keep Melissa the “infant” that Dana was (immediately before her death) to feel as if he were still with her (Dana), this researcher does not have enough evidence to support that idea.
Karl revealed that he has endured multiple significant losses. In addition to losing his daughter, Dana, he lost his mother when he was in college. His experience of losing his mother may be related to his experiences of losing Dana. As noted in Dennis s individual analysis, Leon s (1990) model of perinatal loss suggests that one of the reasons that adults may desire children is to satisfy their wish for reunion with their own mother. Given that Karl s mother died, it is possible that his desire for Dana was rooted in this wish. Hence, losing Dana may have felt like the tie with his mother, or any important female object, was severed, forcing him not only to grieve Dana s death, but also to revisit the death of his mother.
Karl s experience of perinatal loss was qualitatively different from the other participants in terms of the type of loss and the extended amount of time that he had to bond with her. Karl s loss was unique in that his daughter was about four months old when she died. This gave Karl four months of bonding time with the baby (outside of the womb). Although getting to know this baby may have made it hard when she died (as he knew whom he was losing), having these memories with her also may have facilitated the mourning process. While parents with early losses may have difficulty with what Bowlby (1980) described as the searching and yearning phase of mourning (as they do not know for whom they are searching and yearning), Karl had already created clear images and memories of her, facilitating the grieving process. Karl had this experience, and it gave him the chance to grieve the loss. A difficulty of SIDS is the lack of knowledge regarding how the baby dies. This void in knowledge left Karl with unresolved feelings, and it also allowed for further self-blame for the death. It may also have prevented complete closure, since Karl does not know the precise reason for Dana’s death.
Karl s projective and objective tests had contradictory results. His T.A.T. was consistent with his interview, revealing that he was experiencing separation and loss (card two, rater two). Conversely, his PGS scores suggested that he was not experiencing much grief. His total score, Active Grief scale score, and difficult coping scale score were all below the mean, suggesting that he was not experiencing much grief relative to others who scored higher on the PGS. On the other hand, his Despair subscale score was slightly (.01) above the mean. The contradictions in Karl’s data may be explained by recognizing that this grief may be in part, unconscious. The Despair subscale supports this in that the PGS authors suggested that this subscale reflects unconscious grief. This subscale is highly correlated with depression; therefore, Karl might be also suffering from depression. These scores must be interpreted with caution, as the PGS has not been validated on men.
Participant Three: Raymond
Raymond described having a variety of thoughts and feelings in response to Bryan’s stillbirth, which occurred after he was diagnosed with Down’s Syndrome in- utero, thirteen months ago. One of his most prominent feelings was that of ambivalence about having a child, both during the pregnancy and throughout his life. During the interview, he talked at length about how unsure he had always felt about becoming a father. While these feelings are a normal part of pregnancy and soon-to-be parents often feel ambivalent about the pregnancy, the baby, and becoming a parent (Diamond, 2000), Raymond emphasized the long history of his ambivalence.
Raymond’s doubts about becoming a parent were exacerbated by the fact that Bryan was diagnosed with Down’s Syndrome. Raymond was extremely concerned about the “social ramifications” of having a Down’s Syndrome child, especially because of the child’s lower IQ. In his own words, he described this diagnosis as a “blow to my pride and ego,” indicating that he was experiencing it as a narcissistic wound. Raymond’s experience is consistent with the literature on parents who have a child with a disability. That is, having a child with a disability can be a massive narcissistic injury for parents (Leon, 1990). This injury originates from both before and during the pregnancy, when parents have fantasies about their unborn child, often grandiose in nature, representing their ego ideal, on which much of their self-esteem is based. Physical or mental deficits, or in Raymond’s case, intellectual deficits, are experienced as a sense of failure on the part of the parents because children represent a part of themselves (Leon, 1990). Hence, for Raymond, having a Down’s Syndrome child, a child that would be mentally retarded, made him feel that he, himself had a deficit or that he was, in his own words “not good enough.” The high magnitude to which Raymond experienced this narcissistic wound appeared to be related to his “pride in professional activities” and his pride in “a certain degree of mental prowess.” Much of Raymond’s sense of self appears to be organized around his high-status career and his high intelligence; therefore, having a baby who would not have those capabilities damaged his self-esteem.
Raymond described feeling relieved about Bryan’s death, attributing this reaction to his feeling that he was “. . . not strong enough to rise to the challenge” of raising a Down’s Syndrome child. He described feeling guilty over this sense of relief.
Raymond’s sense of guilt can be explained by looking at his unconscious processes. As noted above, ambivalence about having a child is a normal part of pregnancy. In Raymond’s case, his doubts appeared to be greater than his excitement, especially when Bryan was diagnosed with Down’s Syndrome. When a perinatal loss occurs, this ambivalence commonly leads parents to believe that the loss was a result of their own forbidden unconscious aggressive wishes. These unconscious experiences often lead parents to a sense of guilt and self-blame (Diamond, 2000; Leon, 1990). This theory is consistent with Raymond’s described experiences. He reported that his sense of relief caused his guilt. This description suggests that Raymond may have had an unconscious wish that Bryan would not survive the pregnancy, as Raymond did not think that he was “strong enough” to raise him. This could have caused Raymond to feel as if those wishes caused Bryan’s death, resulting in guilt and self-blame.
According to Leon (1990), when mothers lose a baby to a perinatal loss, they experience a narcissistic wound because they lost someone who was literally a part of themselves. Although fathers do not carry a baby inside of their bodies, they still have a part in making the baby. Therefore, the theory that perinatal loss involves a narcissistic injury may still be true for fathers. Applying this theory to Raymond, it is likely that he experienced two narcissistic wounds. The first was in learning that he had produced an “abnormal” child, and the second was in learning that his child died. Leon (1990) believes that creating a dead child can be a blow to a woman’s sense of self-worth. Raymond’s experience expands the generalizability to men. This theory can be applied to men -- Raymond’s experience supports this view. In describing losing Bryan, he felt that he had an “unfinished task” and that he was a failure. Therefore, in addition to the blow to his “pride and ego” of having a Down’s Syndrome child, Raymond also endured the narcissistic wound of creating a dead child.
Raymond described feeling “no sense of loss” over Bryan’s death. His PGS scores were consistent with his descriptions, indicating that he was neither actively, nor inactively grieving the loss. Interestingly, his T.A.T. and C.A.T.-H revealed a sense of loss. On card 3BM of the T.A.T., rater two noted that Raymond might have potential difficulty in resolving feelings about losses. On card five of the C.A.T.-H, one rater noted that Raymond was very sensitive to losses, and that he had a tendency to deny the emotional impact of losses. These results suggest that Raymond may in fact be experiencing a sense of loss over Bryan’s death. He is, however, either denying or repressing those experiences.
This researcher also found it interesting that, although Raymond repeatedly stated that he had “no inclination” to talk about this loss, and had no deep feelings of loss, he participated in the present study, which consisted of two extensive interviews about the loss, and was based on the idea that fathers do experience loss. It is likely that Raymond would not have participated in psychotherapy to talk about the loss. Perhaps talking about the loss in the context of “research” and “helping others” allowed him to rationalize being in the study, rather than to admit to himself that he needed to talk about the loss in order to gain some closure over these painful issues.
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