by Holly E. Dreger, LCSW
Social workers play a vital role in facilitating healing. We use language to obtain information and identify the needs and feelings of others. But sometimes there are circumstances that are so painful they are difficult to assess, especially if they are, by their very nature, a suffering swaddled in silence.
There is a loss that, even today in 2015, does not have a clear name.
President Reagan stated, “When a child loses his parent, they are called an orphan. When a spouse loses her or his partner, they are called a widow or widower. When parents lose their child, there isn’t a word to describe them.” The Proclamation recognized this “nameless loss” and created a foundation for dialogue about this special, often hidden suffering that affects so many.
In October 1988, President Ronald Reagan proclaimed October as National Pregnancy and Infant Loss Month, with October 15th as the official day recognizing pregnancy and infant loss.
Social workers play a vital role in facilitating healing.
The particular suffering connected to perinatal, pregnancy, infant and child loss is that, for many, the loss occurs before the child is known to the parents and to others (such as with an ectopic pregnancy or miscarriage). Often when the anniversary of the loss occurs, reflection about the age the child would be can bring the mourning parent renewed grief. Sometimes the mourning parent enters into treatment around or in anticipation of a loss anniversary, and this is a possibility that can be explored with a thorough biopsychosocial assessment.
Pregnancy and infant loss often occurs in silence, causing a moratorium on grief that can have tremendous impact upon the health of the mother, as well as the rest of the family. This grief can transform into various physical and mental health issues. The loss can be overlooked during a biopsychosocial assessment if a thorough history is not obtained.
There are many reasons why the loss may be mourned in silence: the loss was related to adoption and the parents are avoiding speaking of the experience; there is a subjective experience of misattributed self-blame and shame and a sense of failure regarding the loss (as in miscarriage or birth defects); there is fear of ridicule or unwelcomed comments and weak attempts at helping the parents feel better (e.g., “You can always try for another child,” or the dreaded “It was God’s will”). Kersting and Wagner state that a signature factor involved in the ‘silence’ associated with this kind of loss is that there is no funeral or ritual of mourning connected to the loss of the child as there would be with any other death (2012). This further isolates the parents and can extend their grief.
How social workers assess for pregnancy loss is important, and sensitivity must be utilized in how the questions are posed. They should be neutral, compassionate, non-accusing, yet supportive of the parents, so their story of loss can be shared. A comprehensive assessment would explore recent and remote aspects of a client’s life. Sometimes an open-ended approach such as, “Is there anything you’ve experienced in your life that you have never forgotten or has never left you, perhaps something you’ve had difficulty speaking about?” can allow for the client to bring up a host of experiences that are not specifically tied to any question in the biopsychosocial assessment. More specifically, during the assessment, a social worker can inquire about the number of pregnancies a woman has had, and wait for the response. Asking clients about the number of children they have does not capture any children lost to either perinatal demise, stillbirth, infant, or child death.
In some settings, such as in women’s health, mental health clinics, prison systems, and geriatric settings, the experience of loss in a woman’s life is often exhibited through behavior. The old adage “we repeat what we don’t repair” rings especially true with trauma. Unexpressed feelings about pregnancy and infant loss can behaviorally be exhibited as sexually acting out, obsessive preoccupation with pregnancy, obsessions (e.g., with death, about future losses, cleanliness, need for perfection), self injury (e.g., cutting, burning self), or the abreaction of avoidance or hatred of all things that remind the client of the loss (e.g. not being able to participate in a friend’s baby shower).
The pain of loss is sometimes so distressing that individuals have driven the emotion deep within, but behaviors will eventually “leak out” and serve as dynamic symbols of the loss. This can exist across the lifespan, and it is especially poignant for women of older generations who were often shamed openly for pregnancy loss of any kind. Not allowed to give voice to any of their suffering, these women would endure in silence often until they were of much older age and experiencing the rollercoaster of loss so typical of our elder years. But the pain remains and can leak out in unique ways. According to Herman (1992)
“the psychological distress symptoms of traumatized people simultaneously call attention to the existence of an unspeakable secret and deflect attention from it. This is most apparent in the way traumatized people alternate between feeling numb and reliving the event.” (Herman, J. L. 1992)
According to the author Anne Rice, she wrote the novel, Interview with the Vampire, in part as a means to express her feelings associated with the loss of her young daughter, Michele, who died from leukemia at the age of five. An atheist at the time, Ms. Rice described writing about death as a way to find meaning once again in her life. Writing can serve as a means of expression and healing for many who have experienced the loss of a child.
When parents name their child, it is typically a process of careful discernment. A name carries with it meaning, tradition, and history. It is vital for the social worker to assist the parents with naming their loss, because through the process of naming the loss there could be a context of meaning that facilitates healing and coping. Speaking of the loss gives the parent permission to share with another the cascade of losses, especially the loss of who they dreamed their child would become. This special loss is the loss of the future for so many parents.
Many hospitals, area agencies, and women’s centers offer groups that welcome parents who have experienced pregnancy and infant loss. Contemporary music has also given an emotive voice to this nameless loss (“I want you here” by Plumb; “Heartbeat” by Beyonce; and “Slipped Away” by Avril Lavigne, to name a few). Social workers can facilitate healing by sharing the resources local to the grieving parent, and by giving them permission to grieve a loss that so many have difficulty sharing.
For Additional Reading
Bigwarfe, A. H. (2013). Sunshine after the storm: A survival guide for the grieving mother. Kat Biggie Press.
Burke, T. (2002). Forbidden grief. Illinois: Acorn Books.
Herman M. D., J. L.. (1992, 1997). Trauma and recovery: The aftermath of violence—From domestic abuse to political terror. Basic Books.
Jacques, A. (2014, November 2). “Anne Rice: The Interview with the Vampire Novelist on her daughter’s death, living through her own funeral and the dangers of Oxford. Independent. Retrieved from http://www.independent.co.uk/news/people/profiles/anne-rice-the-interview-with-the-vampire-novelist-on-her-daughters-death-living-through-her-own-9829902.html.
Kersting, A., & Wagner, B. (2012). Complicated grief after perinatal loss. Dialogues in clinical neuroscience, June 14 (2), 187-194.
O’Brien, M. (2007). B-mother. Houghton Mifflin Harcourt.
Holly Dreger is a Licensed Clinical Social Worker who works full time with Veterans. She has worked in the field of social work since 1998 in various capacities and in various treatment settings, both as the practitioner and as a field instructor, mentoring new social workers. She has provided services in elder residential (nursing home), inpatient psychiatric, private practice, outpatient, and partial hospitalization. Ms. Dreger has also been an adjunct instructor of psychology for Eastern Connecticut State University.