A Doctoral Thesis by
Leena Väisänen MD

Editors Note: This review is excerpted by permission of the Author from an Academic Dissertation by Leena Vaisanen entitled: Family Grief and Recovery Process when a Baby Dies.

The purpose of my doctoral thesis was to use qualitative phenomenological and narrative analysis to describe the grief and recovery of families after the death of a small baby. I call my method the phenomenological family therapy approach. The material consisted of narratives produced by 22 families and one focus group during 1993 - 1995 in the form of tape-recorded interviews, notes on crisis therapy sessions and home visits, letters written by the families and phone calls made by family members.

Loss of a baby is always traumatic

The crisis begins from traumatic experiences. The parents transit into the liminal space between life and death. This stage also underlines the paradoxical quality of grief. A logical thought is followed by another, which contradicts the first, as in: the mother feels she cannot respond at all, because she feels dead herself. She cannot be alive, because her baby is dead. Recovery also seems something impossible and far away, although ideas of recovery appear early on in the process, balancing the mind and necessarily protecting the ego from being split . The subliminal time of grief is shown in the altered way of experiencing things. One lives in an altered time with strange symbols, omens, dreams and unusual psychic and physical experiences. The experience of grief is not only stepwise and processual, but multi-voiced and stratified, like counterpoint in music, and there is reciprocal movement within it like in paradoxical loops. The loss of a baby results in grief that runs counter to the expectations. The parents have invested so much primeval energy in the baby who is no longer alive that they tend to re-create her/him in their minds psychologically or spiritually. Grieving thus involves deep attachment rather than detachment, and the processing of this attachment makes it possible to recover.

The somatic aspect of grief

Family grief requires collective tolerance and sharing. The family members huddle close together and set up a wailing wall around them: it is permissible at home to cry aloud or grieve quietly. The quiet, largely somatic aspect of grief is strongly present after baby loss. The mother, and occasionally also the father, may find themselves in a subliminal space between life and death, where the pain of the loss, emptiness and longing is present as physical pain. The loss of a baby in the symbiotic phase results in grief manifested as physical pain and longing, feelings of emptiness, strange sensations and a phantom baby. Some mothers are able to verbalize this better, but all losses involve feelings of distress, restlessness, pain and anxiety which are due to the fact that the mother, with all her finely tuned physiological systems, was intended to keep her baby alive. Although there is no baby, the mother's psychophysiological need to care tends to persist. She is still symbiotically dependent on her baby, who no longer exists as a living being. She is constantly preoccupied with the baby, the grave and death. She may even be so intensely dependent on the grave that she cannot leave the locality. Visiting the grave daily may be important, and even when she does not actually visit the grave, she may be conscious of it. Because the baby is in a grave, the mother may feel for a long time that she is in a grave herself. Phantom babies are symbolic representations of grief and continue their nearly physical existence in the family. The alternative religious metaphor is a baby angel, which splits the traumatic experience into two: the disconcerting body of the baby in the grave and a consoling angel. Grief reflects the psychological and spiritual attachment to the baby that was lost physically and strongly resists abandonment of the baby. It is based on the primeval energy of parental attachment, which is used, although there is no baby.

Grief of family members

The mother's grief process and recovery are reflected in the family's overall coping. If the mother is able to share her attachment to the future baby early on in the pregnancy, the father is able to support his wife after their bereavement. Fathers are generally the best supporters for their wives. The challenge posed by grief to the father is a need to find his own specific grief beyond the mother's grief. In the light of the present findings, young parents who lose their first child need a lot of support. They may have an inadequate support network, having moved to a new locality as students, for example. They have abundant experiences of being left alone. The families who already had a strong social network were given adequate outside support of many kinds. It is important in these families to be able to be alone from time to time. Children were the active parties who interpreted and commented on their parents, and who used use their energy and imagination to console their parents by all possible means. A child may also assume the role of a therapist in relation to her/his parents. In this study group, latency age girls who had identified with their mother's pregnancy appeared to be at risk, because they also lost symbolically the baby or identified with the baby and began to fear for their own death. Children may also have transient age-appropriate symptoms and therefore need an adult to talk about things that are important for them. The basic attitude of children towards death and dead people is natural and curious. Children are conscious of the paradoxical quality of their parents' grief, because they share a cyclic notion of time and way of reasoning. Children are also able to delay their own grief reaction to help their parents.

Time of grief

Grieving takes a lot of time. Although the restlessness, anxiety and depressive moods disappear, grief continues as a long process. The first year is the worst. Each parent has her/his individual schedule. Grief is not something that becomes linearly alleviated, but rather a circular process that is activated by the intense initial guilt and obsessive need to find out causes and details. This study showed the recovery times to vary, depending on the individual personalities of the parents and the family structure. The family recovery process mostly takes place through dialogue between the family members, which allows them to find new meanings. Their goal is to survive the catastrophe by finding new meanings for the family security system, their identity as a family and their world view. The very short recovery times reported in quantitative studies reflect their short follow-up times and the research setup.In this study the atcive grief time lasted usually for two or three years. Grief for the death of a baby continues at some level for ever, although it is not pathological or complicated. When time elapses, the feelings of pain alleviate.