Ambiguous Loss and Disenfranchised Grief

I have recently come across the concepts of complicated grief, ambiguous loss and disenfranchised grief.
They are all strongly linked to fertility losses.

Ambiguous loss refers to losses that are either hidden, secret or not socially sanctioned. This includes infertility, failed fertility treatment and miscarriage (although Miscarriage Services now exist). It includes unwanted childlessness whatever the cause, including lack of a partner. It would include grief over past terminations, even if they were wanted and deemed necessary at the time. (Another type of ambiguous loss would be the death of a beloved pet.)

The problem with ambiguous loss is that the person affected may not be sure herself if she has sustained a genuine loss–since it is not a loss that receives social validation. If you lose a newborn baby, people will write a condolence letter. If you lose a fetus, they probably won’t. Others may not realize that there has been a loss–or may not consider such a loss significant.

Ambiguous losses lead to disenfranchised grief.

Disenfranchised grief can be defined as the grief that persons experience when they incur a loss that is not or cannot be openly acknowledged, publicly mourned, or socially supported.

Rituals do not exist for it or they are difficult to access. The lack of social support leads to increased isolation for the grieving person. This isolation is a hallmark, in my experience, of people with fertility problems.

To effectively mourn losses–including so-called ambiguous losses–human beings need suitable rituals (hence my earlier threat here on the Value of Ritual).

The failure of a society to validate such losses makes it far more difficult for the people mourning to work through their grief.

That can lead to chronic or complicated grief. (Grief is a messy business in any case–but so-called “normal grief” is generally thought to last roughly 2 years.)

Some people are considered “resilient mourners” and bounce back more quickly. On the other hand, those who have had difficult childhoods or a lot of loss and trauma in their lives might be considered “vulnerable” or “fragile mourners”.

If the bereavement of infertility, lost pregnancies, failed fertility treatment and unwanted childlessness is not addressed in a timely way, it may be “stored up” and triggered later in life by other losses–such as the death of a parent, spouse or sibling. That is why it is important to do griefwork as we accumulate our griefs! Shoving it under the carpet is a bad longterm strategy.

In complicated or chronic grief, the tasks of mourning are frustrated and there is no resolution. Life cannot move foreward. There is obsessive preoccupation with the losses and general stagnation.

Complicated grief is identified by the extended length of time of the symptoms, the interference in normal function caused by the symptoms, or by the intensity of the symptoms (for example, intense suicidal thoughts or self-harming).

Symptoms may include anxious moods, disturbed behaviour and/or major depression. Symptoms might also include obsessive-compulsive behaviours–such as working excessively, cleaning obsessively, overeating, drinking too much, over-medicating, sleeping too much–even obsessive use of the computer!

Substance abuse (drug use, smoking, alcoholism, abuse of prescription medications) is often an attempt to avoid painful feelings about the loss and treat symptoms (such as sleeplessness, tearfulness or restlessness).

For more on this topic, the best on-line material I found was here:
http://www.indiana.edu/~famlygrf/units/ambiguous.html

Please share your reactions to and thoughts about this material.

I have cross-posted this material on the Fertility Friends website forum: http://www.fertilityfriends.co.uk/forum/index.php?topic=232737.msg3680987#msg3680987

Music used in fertility loss rituals

Memorial Service Music

1) The Cello Suites, Suite No. 1, Prelude by J. S. Bach, performed by Paul Tortelier (2.30)

2) Carmina Burana excerpt from Cours d’Amours, ‘In Truitina’ by Carl Orff, performed by soprano Gundula Janowitz (1.54)

3) Sometime We Cry by Van Morrison from the album, ‘The Healing Game’, sung by Van Morrison with backing vocals by Georgie Fame and Brian Kennedy

4) The Lamb by John Tavener, words by William Blake from the album, ‘Innocence’ (used in first service, 1999)

5) Song for Athene by John Tavener from the album, ‘Innocence’

6) Lean on Me by Bill Withers performed by Michael Bolton, on his album ‘The One Thing’

7) Hand it Over by Keb Mo from his album ‘Just Like You’

8) Feel Something Drawing Me On by Sweet Honey in the Rock from their album of the same name
9) Tears in Heaven by Eric Clapton

10) Stand by Me (various artists)

Musical taste varies.

If you have suggestions for other music that might be effective, please post them!
Live music is always especially nice, but recorded music will do.

An easy way to organize the music is on an iPod (making a playlist).

For the ceremony, the iPod can be plugged into an existing sound system (requires a simple cord) or if no sound system exists in the venue, use an iPod amplifer. These are not expensive and some give a good sound. Buy or borrow one. Some are battery powered, so work outside without electrical current.
Errors in music cues can be disturbing–so they need to be rehearsed ahead of time by the person who will be responsible for the audio. It’s not always easy to work out the right volume–so rehearsal in the place where the ritual will take place is essential.

Fertility Loss Ritual–Text for a group ceremony

I just posted the complete text of a typical fertility loss ceremony as a permanent file under the CONTENTS heading.


Mothering Sunday

Today is Mothering Sunday in the UK.

For women who have not been able to have the children that they’d wanted, it can be a particularly painful day.

I happened to hear the broadcast of the “Morning Service” on BBC radio today, which was focused on motherhood. This week’s broadcast came from a Catholic Church and they dedicated their service to the Virgin Mary. I was pleased to hear the woman speaker specifically including women who had not been able to have children–or women who had lost babies.
When I lived in London, we used to run a Fertility Loss Ceremony for all those people who were grieving the absence of a child in their lives.

The text of that service is available, free, by internet–should you wish to organize a similar ceremony in your community.

There is also a collection of readings that we used during the service over the years.

The archetype of the Mother is made up of various qualities: Abundance; Dignity; Respect for Life. Loving and Nurturing impulses towards all creation and the Human Family–not just our own genetic children.
Like Gaia–Mother Earth–CREATIVITY is a hallmark–but on ALL levels–not just biological. Artists who bring forth art in all manifestations; creative cooks, gardeners who nurture plants; keepers of the hearth who tend the fire and make the home a refuge of beauty, peace and support.

Mothering Sunday is also a good moment to consider who mothered us–nurtured us–so that we could become our fullest, most highly-developed selves–and to THANK those people (female or male).

For me, this includes Mabel–a wonderful American black woman who was a second mother to me. I would also include my grandmother, my therapists over the years and a few special friends who have stuck with me through thick and thin.

Who nurtured you?


The Value of Mourning Rituals? What’s YOUR view?

I’ve been invited to speak at a conference of in/fertility in Rome this June  (ESHRE Special Interest Group Psychology & Counselling) concerning the value of mourning rituals for the unwillingly childless.

I am interested in hearing from you.
Have you taken part in any such rituals–private or public?
If so, what were they like?

Were they helpful?

I have facilitated such ceremonies myself.

If you’ve attended one of those, did you find it worthwhile?

Did anything “stick”? Change?

The service we developed (two other women counsellors were involved) is meant to feel equally suitable for those who have no spiritual beliefs as for those who folllow some faith or spiritual path. No clergy officiate.

Our service was also designed to be as participatory as possible.  There were activities that everyone could participate in (or NOT) as they wished.  We felt that this would make the ritual more meaningful for participants.

I’m interested in any kind of feedback.

It’s not often that the profession of fertility doctors, nurses and counsellors have an opportunity to hear anything about this–and I’d like to represent a wide scope of experiences and views.

With thanks!

Meredith