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Participant Four: Peter
Peter described several reactions to the death of his three-day old infant that occurred after her premature birth four months ago. One of Peter’s most apparent reactions in response to his daughter, Tabitha’s, death was avoidance. He avoided thinking about her death, and focused, instead, on how to prevent a future loss. Throughout his interview, Peter emphasized how he tried not to think about the loss, rationalizing his behavior with such statements as, “That doesn’t help me—just to sit there and think about it.” Peter’s reaction to his daughter’s death is consistent with Puddifoot and Johnson’s (1997) report that many men use avoidance as a defense against their feelings about the loss, just as these men commonly stated that they try not to think about the loss.
Related to Peter’s avoidance was his minimization of his feelings about the loss. He reported feeling little conscious sadness about Tabitha’s death. Peter’s projective tests, however, revealed that he was experiencing a sense of loss. Rater one, for example, noted that on card 3BM of the T.A.T., there was a theme of loss. Consistent with the literature, these results suggest that Peter’s sense of loss may be unconscious. Zeanah, Danis, Hirshberg, and Dietz (1995) reported that some men who suffered a reproductive loss are what they labeled “minimizers.” A minimizer is someone who is more defensive about the loss, is not consciously grieving the loss, and represses his feelings about the loss. Peter’s minimizing of, and avoiding his feelings about the loss is consistent with findings on his T.A.T. and C.A.T.-H. Rater two noted that on card 3BM, Peter avoids his deeper feelings, particularly his depressive ones. Similarly, on card five of his C.A.T.-H, rater two noted that Peter tends to deny more negative emotions. On card nine, he noted that Peter tends to deny stronger, more negative feelings. Peter’s PGS scores were all below the mean. Given that the PGS scores were low, and his denial of having had difficulty since the loss, it is likely that his grief is primarily unconscious. An integration of these findings suggests that Peter’s reactions to Tabitha’s death may be more severe than he acknowledges, and that they are primarily unconscious.
Another theme for Peter was that of prevention. He repeatedly told the interviewer that he focused more on learning about his wife’s medical condition in order to prevent future physical problems having a baby, rather than “dwelling” on the fact that the loss occurred. Peter’s focus on prevention can be understood in a variety of ways. One explanation is that it serves as a way to feel more in control of both the loss and his wife’s illness. Although he did not mention feeling helpless during the interview, it is likely that he had this feeling. He may have tried to contain and feel more in control of his helplessness, while attempting to prevent future losses by educating himself on the medical condition. His focus on prevention may also have been related to his sense of guilt and responsibility over the death. During the interview, Peter repeatedly mentioned that he regretted not doing more to learn about Laura’s medical condition, which he believed would have prevented Laura from having to deliver so early. Perhaps educating himself not only enabled him to feel more in control of future events, but also served to “undo” his guilt about not doing more to prevent the loss.
Participant Five: Ryan
Ryan was a unique participant in this study in that he was the only one who had had two perinatal losses. He described his two losses (e.g. a miscarriage and a stillbirth), occurring eight and three months ago, as being very different from each other. He felt that losing his first baby, Pat, to a miscarriage was much less difficult for him than losing Belinda to a stillbirth, as he was much more bonded with Belinda. This can be best understood when considering the circumstances surrounding the miscarriage, as compared to the stillbirth. The miscarriage occurred early in the pregnancy, before Ryan even saw an ultrasound scan, leaving little time for him to bond with the baby. As Ryan was not physically capable of experiencing Pat grow inside of him, and was not able to feel any of her movements, he was further excluded from the bonding process. Ryan was never able to interact with Pat as a deceased baby, or to hold a funeral ceremony; these procedures would have increased the reality of the baby, facilitating mourning. Without these bonding experiences, the baby was less “real” to Ryan.
Ryan felt like an outsider to both the pregnancy and Pat. Consequently, after her loss, he decided to become very involved with the second pregnancy. For instance, he attended appointments with his wife and built a web site to share pictures from her ultrasound scans with his friends and family. Thus, he was able to both “feel more a part” and to bond with Belinda. Perhaps these activities served as a way for him to cope with his helpless feelings surrounding Pat’s death, as if he could be more “in control” of what was going on with his baby this time. These activities may have further served as a way to make his previous baby more concrete. Seeing ultrasound scans of Belinda may have given him clearer images of Pat.
Ryan continued to be involved with Belinda after her death. He celebrated the day of her delivery by having friends present, where everyone held Belinda and took pictures of her. He also had a large funeral, with over one hundred people present. As noted with the other participants, viewing and interacting with one’s deceased baby facilitates the mourning process. It helps parents create clear images and memories with their baby (Leon, 1990; Lewis, 1979), allowing them to successfully complete Bowlby’s second phase of mourning, searching and yearning (Lewis, 1979). Perhaps this process was particularly relevant for Ryan because, as a father, he was not able to bond with Belinda through a physical connection. This process may have further helped him clarify whom he was losing when he lost Pat.
Interestingly, Ryan talked at length about how losing Belinda was much harder for him than losing Pat. Perhaps when he lost Belinda he was not only grieving her loss, but grieving Pat’s death as well. Ryan’s sense of loss of Pat may have become more real through his bonding with and grieving of Belinda.
Ryan’s description of his sense of grief and loss in his interview was consistent with the results of his projective tests and the PGS. His projective tests revealed that he was experiencing a sense of loss. Rater one noted that card 3BM of the T.A.T. indicated a sense of loss, as did card 3 of the C.A.T.-H. Ryan’s PGS scores indicated that he was not actively grieving, but was having more severe reactions, had some difficulty coping with the loss, and was in despair. Applying Potvin, Lasker, and Toedter’s (1989) explanation of these subscales, these scores suggest that Ryan is having a hard time dealing with people and activities, may be experiencing a more severe depression, is withdrawing from others, having trouble functioning with daily life, and may have more serious and long-lasting detrimental effects resulting from the losses.
Ryan talked about many psychological experiences after his losses, the most prominent ones being guilt, a sense of disorganization, and self-blame. Although Ryan rationally knew that he did not cause Belinda’s death, he felt that his behaviors (i.e., her exposure to paint, his failure to remove mold from some wallpaper) could have caused her early death. Furthermore, he wondered if he could have done something to prevent the loss. Unlike Dennis’s, Ryan’s guilt was conscious. Guilt is commonly seen in mothers after perinatal loss (Leon, 1990). Because this researcher had not found any literature discussing guilt experienced by fathers after perinatal loss, this discussion will build on those theories about mothers. Ryan’s guilt served to make him feel more in control over his sense of helplessness. Perhaps Ryan’s sense of helplessness was compounded by having two perinatal losses, increasing his need to feel in control of these emotions, and leading to a strong sense of guilt. As noted earlier in this chapter, guilt is commonly experienced among mothers after a perinatal loss because pregnancy prepares them psychologically to take complete responsibility for a completely helpless infant, leading to a sense of guilt and self-blame when a loss occurs (Leon, 1990). The results of the present study suggest that this theory can also apply to fathers.
Interestingly, Ryan mentioned a particular philosophy of life, which when coupled with an event that occurred in his past, could have compounded his present level of guilt. He reported that in his early twenties, his girlfriend became pregnant with his child, and she had an abortion. Although he did not want her to have this procedure, he now believes that it was the right decision. Ryan believes that the abortion “kinda affects” him now that he has had perinatal losses; however, he would not elaborate on how it affected him. Leon (1990) believes that when a woman has an abortion prior to a perinatal loss, she may experience the loss as a punishment. Applying this theory to Ryan, he may feel that his two losses and his inability to have a living child up to the present time are punishments for the earlier abortion. One factor that may be exacerbating his guilt over the abortion is his philosophy of life, briefly mentioned in the interview -- “good things happen to good people.” This belief suggests that bad events only happen to “bad” people. Perhaps he now believes that he is a “bad” person for having had that abortion, so bad events (the two losses and being deprived of fatherhood) are the consequences.
Ryan’s most prevalent symptom was that of disorganization, as he reported again and again that he was in a state of disarray since Belinda died. He described having trouble concentrating and completing projects, and that he was experiencing confusion. His state of disorganization is consistent with what has been reported in some popular grief models (Bowlby, 1980; Lindemann, 1944). Bowlby (1980) identified disorganization as his third stage of grief, while Lindemann (1944) identified the loss of organized patterns of conduct as one of the five components of grief.
Ryan’s disorganization may also stem from the regression associated with perinatal loss. Perinatal loss occurs when parents are already in the regressed state of pregnancy, making them very vulnerable. Ryan incurred two losses in this regressed state, one compounding the other. Therefore, it is likely that his disorganization is a result of this regression.
Ryan’s psychological experiences are also related to the fact that these losses have prevented him from becoming a parent. Some theorists consider parenthood to be a developmental phase or task in adulthood (Colarusso, 1990; Leon, 1990; Parens, 1975). Theresa Benedek, the first theorist who conceptualized parenthood as a developmental phase (Parens, 1975), believes that during each “critical period” in their child’s development, parents have the opportunity to re-experience and rework those phases of their own development to achieve a new intrapsychic level of organization (Parens, 1975). Some theorists have emphasized the adult developmental tasks that parenthood fulfills (Colarusso, 1990; Erikson, 1964). For instance, Erikson’s theory of generativity, or guiding the next generation, is widely known. Becoming a parent is not the only way to fulfill generativity, but it is one of the most common ways to do so. Colarusso (1990), considering parenthood to be a developmental task, applied Margaret Mahler’s theory of separation-individuation to adults, stating that becoming a biological parent is the third separation-individuation phase. Colarusso believes that by having a family, an adult further separates from his own parents, fulfilling an adult developmental task. Perinatal loss interferes with this progression into parenthood, especially in the absence of existing children, compromising the entrance into this developmental phase. Thus, Ryan is not only mourning the losses of Pat and Belinda, but also mourning the loss of opportunity to fulfill this adult developmental task. Although he and his wife Megan plan to try to have another child, they are faced with the fear that they might not be able to give birth to a live, healthy child.
Ryan talked about a variety of ways he coped with his loss, the most salient being that he raised a fund to create “packages” for parents in the future when they have a perinatal loss. It was obvious during the interview that creating these packages was important to him, as he talked about them with pride and in great detail. The importance of these packages to Ryan can be explained by looking at the narcissistic wound associated with perinatal loss. As discussed in Raymond’s section, Leon (1990) believes that perinatal loss is a narcissistic wound because the baby is literally made up of the parents’ selves. Although his theories are based on women, they have been applied to men in this section. Having a baby can enhance parents’ sense of omnipotence and self- esteem, representing their ego ideal. Therefore, losing their baby can be a blow to their self –esteem and sense of omnipotence. Perhaps for Ryan, creating those packages was a way to “finish” creating something. Symbolically, those packages were a part of Ryan, perhaps being his “baby.” Thus, they may have enhanced his self-esteem.
Another explanation for Ryan’s creation of these packages is that it served to cope with his sense of guilt. As discussed earlier, Ryan felt extremely guilty for both of his losses. By helping future parents by creating packages for their babies, he may have felt more in control of his sense of helplessness, redeeming his sense of guilt over his own losses.
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