Miscarriage, Abortion and Childlessness - Essay Example

Miscarriage, Abortion and Childlessness, does finding meaning make it easier? ‘Emotion, which is suffering, ceases to be suffering as soon as we form a clear and precise picture of it’ (Spinoza, 2004). In this essay, I will attempt to describe the way in which my experience in Experiential Contact Group, personal therapy and growing knowledge of psychotherapeutic theories has led to increased self-awareness. I will try to chart the gradual realization of how the beliefs, feelings and emotions surrounding my abortion, miscarriages and childlessness have been manifesting themselves. I will also explore how I think this may be affecting other areas of my life.  Due to work and personal commitments, I delayed taking my place at the Minster Centre for a year and during that time; in October 2008 I became pregnant. This was what my partner and I were trying for and we were thus overjoyed. We had been coming round to the idea that we would have to seek help with conceiving or go down the adoption route, as I am 41 and we desperately want a child or even children together. In December 2008, I unfortunately suffered my second miscarriage. As I was already in therapy I felt that I was supported and that I had a safe place to talk this through and so declined the offer of ‘help’ from my G.P. In reality, I mentioned my miscarriage now and again in my sessions and then hurried on to talk of things less painful and more familiar. I was comfortable to talk of my miscarriage in relation to other events in my life but did not seem able or willing to consider this as a topic able to be discussed or explored on its own. I talked about it with my partner, Paul; he was so desperately trying to be positive, telling me that we would soon be pregnant again and that it was just a ‘test run’. I did not feel that I could tell him how dark my thoughts were surrounding this and how I really felt. It would have been difficult to show where I was going with my thinking and consequently my feelings to anyone as I could hardly bear to look myself. I had never received counseling or support for my first miscarriage, which was a very traumatic event in my life, possibly one of the worst things that I have ever experienced. My partner was away on a 3-month trip with the Navy and could not be easily contacted. I was relying on my family for support but they were ambivalent as they were not happy that I was not married and was pregnant whilst also excited and pleased to see me so happy. It did not really occur to me that anything might go wrong and I was happily planning a future, thinking of names, imagining our lives with a new baby. My sister-in-law who already had two children was excited too. She had started to treat me differently and include me in conversations about children, babies etc as if I had gained entrance to a new club. My relationship with my mother had always been very complicated. I had always had difficulty seeing my separateness clearly but as I was pregnant this was slowly beginning (albeit grudgingly) to take a change for the better. My mother and I both acknowledged me as an adult woman and soon to be mother in my own right. My feelings were ambivalent too, as I had guilt surrounding letting my family down and a deep fear of childbirth but I would certainly say that the overriding feelings that I was experiencing were ones of joy and excitement. When I started the fast track foundation course and we were split into our experiential groups I had terrible feelings of anxiety, as if something about me was going to be uncovered and that it would be too much to bear, too overwhelmingly embarrassing, shameful, or painful for me to be able to face and continue the course. Again, this is in retrospect, at the time I can only remember feeling fearful and wrong, but not knowing why and becoming increasingly impatient with myself for not wholeheartedly embracing this experience. I felt as if I was fighting against myself, as I had been eagerly anticipating taking this course for over a year, felt I had finally found my vocation and yet here I was, feeling as if I would burst with anxiety and tension and frustratingly unable to speak freely. I was able to express my feeling of vulnerability but immediately felt even more vulnerable and so became quiet.    Quite early on in this group, somebody brought up choosing to have children and I spoke of being ‘carefree, hedonistic and wild’ in my 20’s and early 30’s and of ‘choosing’ not to have children then but of how sad I was now that I didn’t have a child. Saying this in front of a group of people was quite a shock and although I didn’t go into detail felt very exposing as I knew what I meant. It didn’t feel quite right, something about it felt, as though, I was self-castigating. I can see now that I presented myself in the light of my own harsh self-judgment for my peers to judge accordingly. Something I have never talked of was that between having my first and second miscarriage I had an abortion. This is one of the most painful, sad and lonely experiences that I have ever had and would have complete empathy for someone else if they disclosed this about themselves. My thinking around this part of my life, something rarely broached since it all happened, has been full of self hatred and blame, thinking I somehow deserved the miscarriages and that I was ‘bad’ and had ‘killed my baby’ concerning my abortion. Not only did I experience these awful life events alone but also lived with my feelings and very dark thoughts concerning this alone as I did not feel able to express thoughts such as these or allowed to. Therefore, this was my choice of expressing this, a group full of strangers. Misrepresenting myself in a way that left very little room for anyone to relate to me or have empathy with me and almost offering myself up to be condemned, except that I was so vague that it was probably quite difficult to actually know what I meant. Since then until recently, I have been very quiet, withdrawn, and uncomfortable in my experiential group, almost waiting for the worst to happen. Through looking at Existential therapy, Gestalt Therapy and reading about projection and dream therapy (amongst others), I have become more aware of what I have been doing in-group. I can now identify a pattern I have repeated quite a few times during my life, which in the Gestalt cycle of experience would be identified as using retroflection as a method of interrupting my connection or contact with my environment. By seeing this within a group context I have been able to bring it to more conscious awareness in my larger experiential group, or daily life! I have also had more vivid dreams since beginning the fast-track course, one of particular significance to this subject matter, which I will explore further. Reading Victor Frankl’s  ‘Man’s Search for Meaning’ has also had great resonance with me, even though Frankl is describing life in a concentration camp, finding purpose and reason when all is stripped away. My feeling of losing a child before it is born so that there is no visible child to mourn for, no memories or life experiences and a lack of recognition of the significance of such a loss by society has been a very stressful and isolating experience. My first miscarriage was so lacking in any social and emotional support that would be provided with any other type of bereavement that I suppressed my grief feeling almost shameful for feeling so bereft and unable to ‘move on’. I was told that 1 in 3 pregnancies end in miscarriage; strange that very few women I know seem to have been willing or able to identify themselves in this high statistic. It seems very clear that society’s inhibitions around miscarriage deny women the right to mourn healthily. Looking at this from a gestalt viewpoint, I would argue that our society does not allow or make provision for a complete gestalt to take place. I needed to mourn for the loss of my fantasy children, they had been internal entities within my body who I had been aware of with every breath I took, every decision I made. I had named them and fantasized about our futures together feeling whole and complete than ever before in my life. Not only did I lose three babies, I also lost a part of myself. Firstly in that I took something inwards and hid it from others and myself. Secondly, I have lost part of my ‘why’. I had not realized how important and fierce my impulse and desire to be a mother was. With every passing month, I feel that part of my reason for living, part of my destiny is slipping away. I work with children every day and even though I love my job, some days it feels unbelievably painful and unfair that I am not a mother. When friends talk about their children, I feel incomplete, unable and unworthy of joining in with their conversation. Even worse than this, as I have started to realize it really might not happen for me at all, that I have not just left it late I have begun to feel envious of my friends and family who have children.  Bereavement is a major risk factor for physical illness, grief, depression and anxiety (Beutel et al., 1995). There is a tendency to equate grief with depression but there is a careful discrimination that needs to be made between the two. Grief is a normal self limited response to loss. It can be understood to be an adaptive way of coping with loss. It has manifestations in the health cycle such as depression resulting in a melancholic conclusion. Research related to grief and its management has been hampered conceptually and methodologically because of an understandable absence of objectivity within the case being analyzed and the ones doing the analysis. Despite these shortcomings there are Based on a review of recent psychosomatic studies there are suggestions that recommend the need for serious psychiatric and physical help. This help is needed as the consequence for object loss, which in most cases results in what is known as the depressive reactions. These reactions manifest themselves as hopelessness and helplessness. This can be understood pathological terms where it is known as chronic grief. I am now experiencing is grief for the losses that I have suffered in the form of three children lost. I have tried to understand grief in the form of cold statistics, and these although in no way relatable to the reality of what I went through, it helped me understand and deal with my grief in better. I am having feelings of irritation, guilt, my self, being empty, lonely and gloominess. All of this makes me wonder about the kind of research and acceptance that the society gives to women that have had a miscarriage, the feelings of guilt and depression that the woman has to deal with, the incomplete gestalt and the role of psychotherapy in healing the scars that a miscarriage leaves in its wake. Theoretically, happiness is defined as a feeling that causes pleasure or satisfaction. It is a prolonged or lasting emotional or affective state that feels good or pleasing (Duerzen, 2008). The idea of therapy would be to take the person from being in a state of grief and place him/her in a positive and emotionally healthy phase, which would be lasting. The idea in favor of psychotherapy is that it helps remove the confusions of everyday existence. It might be especially helpful in my case given the vaguely defined by the constant existentialist confusion and guilt that I am living with on a day-to-day basis. What I, am undergoing is a life that is childless due not to choice but to loss; need a vent for my grief and guilt. Miscarriage and abortions are both losses that the mother needs to deal with and yet they do not give the mother time to adjust to loss. Although, in society one in five pregnancies end in miscarriage there is no recognition of the trauma that post-miscarriage life means for the one suffering the loss. The reason for this is that there is no bonding between the mother and an unborn child before occurrence of physical changes. An early miscarriage should leave no scars. I tried reading up on some of the research that in academic circles relating to trauma after child loss due either to a miscarriage or an abortion. The study, published in the journal BMC Medicine, used tests to measure the extent of intrusive thoughts, feelings and flashbacks about the end of pregnancy. The researchers also assessed how much women avoided thinking, talking or feeling anything about the event. The study found that, after 10 days, 47.5 per cent of women who had miscarried suffered from some degree of mental distress compared with 30 per cent of the abortion group (MedScape, 2002). The proportion of women who had a miscarriage suffering distress decreased during the study period, to just 2.6 per cent at two and five years. Levels of distress remained high in the abortion group. After two years, 18 per cent were still experiencing distress, with 20 % at five years. Through interactions with others having others with similar experiences I have understood that grief is universal although in differs in the actual degree and the time it takes to get over the loss and move on with life in an actual sense. There are those that who take miscarriage in their stride and try again and others who feel a deep sense of loss, regret and guilt and go into depression ranging from mild to extreme. There is also the issue of the number of miscarriages that a woman has. I had undergone two beside an abortion resulting in childless existence. I find identification in a something that I read, “The mourning process became shorter after each miscarriage, because I was resigned to failure and did not actually think each pregnancy was real…after each miscarriage I went about business as usual. No one else could possibly feel as bad as I did, and besides, I had a sense of terrible shame and failure”, (Diamond, 1996). The group has helped me recognize the source of my grief. While I was pregnant, there were enormous physiological and psychological changes that I underwent. These served to make rational thought and action tough. It was a major transitional event and a symbol of regeneration and fertility; it allowed me to be effortlessly creative and gave vent to my needs of a wanting to have my child, to be a parent and of being mothered at the same time (Feltham and Horton, 2006). I was more emotional and aware of my person and myself. The problem with loss however was that there was never any tangible person that I could mourn, it was the mourning of the dreams and the fantasies that were associated with my pregnancy, the thought of the much wanted children. There were few outlets that could be an outlet for the acknowledgement of grief-no funeral, no condolences and little compassion. Research into the feelings of feeling less of a woman and feeling like a failure that does not belong can found resonance in women’s developmental theories and socio-cultural expectations that typically link feminine identity to motherhood (Motherwell and Prudent, 1998). This leads to internal conflict for women who remain childless, whether by choice or by circumstance. This, in fact explains a big part of my present feelings of being a failure, of being envious and feeling like I just do not belong. There are suggestions that group psychotherapy can be useful in that it is a place where the intrapsychic and social interact. As an arena for personal change, group therapy is a place where childless women can heal the grief, shame, and guilt associated with their childlessness, and explores other ways to express femininity, creativity, and generativity. As a form of psychosocial therapy, group is a setting where both men and women can closely examine their sociocultural expectations regarding childlessness and debunk stereotypes. The best approach to deal with these feelings of lose probably is the optimal therapeutic approach which is most relevant; it lessens threat and allows the client to experience the counselor or the therapist as understanding. The approach focuses on the understanding of the client needs. The idea is to provide unbiased information and support. The idea, is to imply that professional help is needed and an acceptance of the fact that the abortion or the miscarriage is not a normal occurrence, that the one facing the loss has a right to ask for help. Theory and research also informs that interventions can be a useful tool as well as they help facilitate decision making and mourning while assessing the potential risk. The idea is to provide time limited counseling or therapy, which provides gentle encouragement and empathetic listening by usage of open-ended questions that explore the specific surrounding circumstances and meaning of the loss in individual cultures and contexts. This uncovers added vulnerability such as abuse, addictions, or as is more relevant to my case-depression and family problems. There is also scope for insight oriented, interpretive and open-ended psychotherapy. This could be helpful because most women experience significant yet illogical guilt and self-blame after miscarriages or abortions. I felt shy and nervous discussing my abortion omitting the information wherever I could because I was guilty of taking my own child’s life and that resulted in the loss of another child-one that I wanted desperately... The buried feelings that have not been dealt with are brought to the surface and unresolved grieving that has been squealed by depression, persistent guilt, avoidance, and nightmares and sexual and relationship problems. There are issues of poor adjustments after abortion manifesting in symptoms that are close to posttraumatic stress disorder. The effect of psychological stress on abortion has never been documented, but its role in recurrent idiopathic abortion was indirectly demonstrated by Stray-Pedersen and Stray-Pedersen (1988). In a study of 205 couples with idiopathic recurrent miscarriages, 116 women were offered a ‘tender loving care’ type of psychotherapy in a subsequent pregnancy and 89 were not. Of the women who received tender loving care, 85% achieved a successful pregnancy. Of those who did not, only 36% were successful. It is difficult to set up a prospective study to demonstrate the role of psychotherapy on an ongoing pregnancy because many factors are involved in the start of pregnancy and its maintenance. However, attention should be given to the psychological health of women who experience spontaneous abortion and their partners, particularly if these women exhibit depression, guilt, and grief reactions (Apgar and Churgay, 1993). Adler and colleagues have summarized well the available information about the emotional and psychological impacts of abortion. They use a stress and coping model, in that an unwanted pregnancy and abortion, seen as potential life stressors could have both negative and positive consequences. Whilst reducing stress it can become a stressful event itself. The morality of abortion, the support that one gets from the partner and others and the experience of the abortion itself are all-important. The process of grief is not a unitary one through which the individual moves at a predictable pace; it is a series of signposts to the important component in their emotional reactions (Monach, 1993). Rituals are important in the process of healing and can help in the alleviation of grief. The idea should be to encourage the ones suffering loss to mark and remember their baby, not lock the loss away in a closet, and not think about it. An appropriate memorial service is not a bad idea either. Hardly any systematic attempts have been made over the years to evaluate the experiences of the ones enduring a childless life (Tackett, 2005). The literature in fiction and in personal accounts on the other hand have served to emphasize the extent of the personal pain experienced and thus to point to a more careful study of these experiences. The aim of counseling is to provide psychological space to acknowledge hidden loss, explore hopes and rebuild shattered self-esteem while the natural healing process takes place (Feltham and Horton, 2006). Finding meaning behind loss and actively dealing with the loss helps because there is feeling of a support system, that one is not alone in facing the grief and that the one who underwent the miscarriage was not at fault. The scrutiny of every possible cause, the denials and the bargains to regain a sense of control over an inexplicable event can help one come to terms with the loss and deal with it in a more effective manner. It can help one ‘move on’ not just in name but also for practical purposes. Adoption may not seem like such a good idea given the fact that there is a feeling of marginalization by other mothers who have biological children. Conclusion: Nietzsche's words, 'He who has a ‘why’ to live can bear with almost any ‘how’. In conclusion, the quote from the book, Man’s search for Meaning, would help us find the resonance of the discussion and conclude the argument with a high level of conviction. Childlessness is like a situation that we cannot change– it needs to be thought of as an incurable disease– it challenges the one facing it. Psychotherapeutic application finds place here, as it helps the one suffering loss understand the simple fact that there is first, no need for guilt for having had a miscarriage; it can also help remove guilt about abortion and subsequent and unrelated childless situation. Therapy helps understand the manner in which one needs to deal with the general prejudice and unhappiness that accompanies a childless situation-related sympathy and social moroseness can be better understood and dealt with. Miscarriage, an abortion and childlessness are conditions that need professional help, they need psychotherapy and a healing process which is time driven if there is to be a scope of a free and happy life for ones who have already seen huge losses in a small lifetime. Finding meaning in the loss does help cope with the loss in a better manner and it helps recognize options deal with reality and to move on. Reference: Stray-Pedersen B and Stray-Pedersen, S, 1984, Etiologic factors and subsequent reproductive performance in 195 couples with a prior history of habitual abortion, pub, Am. J. Obstet. Gynecol, vol.148, pp140–146 Stray-Pedersen, B. and Stray-Pedersen, S. (1988) Recurrent abortion: the role of psychotherapy. In Beard, R.W. and Sharp, F. (eds), Early Pregnancy Loss: Mechanism and Treatment. Royal College of Obstetricians and Gynecologists, London, pp. 433–440 Motherwell L, and Prudent S, 1998, Childlessness and Group Psychotherapy: Psychological and Sociological Perspectives, pub Springer link Journal, Vol.22 No.3, pp145-157 Monach J H, 1993, Childless, no choice, pub, Routledge, pp109-114 An Alternative View on Mothers Holding Stillborn Babies, pub, MedScape, accessed June 25, 2009, Feltham C and Horton I, 2006, The SAGE handbook of counseling and psychotherapy, pub, Sage Publications, pp435-440 Tackett K A K, 2005, The Handbook of Women, Stress and Trauma, pub, Routledge, pp63-67 Duerzen E M, 2008, Psychotherapy and the Quest for Happiness, pub, Sage Publications Ltd, pp120-126 Beutel Et al., 1995, Grief and Depression after miscarriage, Their separation, antecedents and Course, pub, Psychosomatic Medicine, Vol. 57, pp517-526 Frankl V, 1984, Mans’ search for meaning, pub, Washington Square Press Read More