Perfect Grief-Most is Perfectly Normal

The many roads & paths which grief takes, can baffle a parent already in deep emotional pain. Experiences which would normally not seem normal at all, are quite frequently reported by mothers who have lost an infant. Many years ago when I worked onsite at a large regional Medical Center, we met with bereaved parents about a month to six weeks following the death of their infants. While most would discuss such feelings and experiences as a loss of appetite, trouble sleeping, or pangs and waves of grief, few immediately opened up to some of the more troubling aspects of grief, for fear they would be seen as 'abnormal' or worse, for fear that they might really have abnormal feelings. The whole range of human behavior and emotion can take place in reaction to loss. Because we do not discuss death openly, especially the death of an infant, a lot of feelings and seemingly strange perceptions and thoughts go unspoken, and often parents hide their dismay at their experiences for years.

What is 'normal' in grief and what is 'abnormal' is a hard definition: in early grief, almost anything can fall into the range of 'normalcy': this includes repetitive behaviors, hallucinatinatory experiences and even despair. The same behaviors or occurrences many years later might well be seen as 'problematic'. The two criteria which Colin Murray Parkes, the famed British Psychologist found which indicated morbid, or troublesome grief had to do with length of duration and increasing rather than decreasing intensity.¹

Cultural differences as to what is normal and what is not also play a role. In one study of widows, Yammamoto et al² found that close to 90% of widows reported 'seeing' their deceased husband while the figure was very low for American widows. The reason was that Japanese culture 'allows' this as a normal experience, even expects its, whereas western cultures frown on seeing or hearing things that are not generally seen or heard. When careful questioning is conducted, one finds that many if not most mothers may hear 'phantom crying', dream about the baby intensely, feel guilty for no reason, or even still think they feel the baby move: all are cognitive-emotional efforts at 'finding' the baby who is 'lost'. It is not that mothers do not understand the baby has died: they understand. But thinking and feeling in intense pain does not take on the same patterns that they do in normal circumstances. Great latitude must be given.

Common but Troubling Experiences

In the next paragraphs, we will explore common but troubling experiences that many parents report. Realize that if these experiences occurred in the day to day world without a relatively recent loss, they would indeed be troubling and even require serious attention. Our minds and hearts heal differently, though, and even when we know clearly what is right and wrong, what is real and unreal, we still under great trauma may experience the whole range of human experience, including delusions and hallucinations and still be perfectly normal. In grief, as the mind tries to redefine what it means for the child we hoped for to be missing, lost or out of our lives in some other way, the mind may 'play tricks' or we allow ourselves to be deceived into certain beliefs which we would otherwise not entertain in ourselves or others. Grief is often accompanied by unusual beliefs, such as thinking we have 'found' the person momentarily, or seeing a vision of the person or hearing them for an instant. Some may belief in the child 'speaking' to them or some feeling that they have violated the sacred if they give something intended for the child away. In early grief especially, both parent and caregiver need to give great latitude and instead of condemning the experiences or suppressing them, or worst of all immediately assigning every little outburst or expression of pain to 'mental illness' [whatever that is], it is better to allow reasonable expression and not run to categorize every extreme thought or emotion as indicative of a serious problem. For most, the truly serious problems come not when pain is expressed but when it is suppressed or even 'repressed'---buried deep down inside. A few problems, when they occur early will need to be attended to but the key is broad latitude and a focus on loving support and listening and caring instead of 'analyzing', condemning, or 'assessing'.

Shock, Numbness and 'Non-reaction'

We have already discussed in other portions of this site the wave of shock and numbness that appears early in grief. When a parent is alerted that their child has been stillborn [true also for any death or disappearance] the immediate response for most is hot searing pain. The anguish at that moment and a 'rage against life' is normal and common, but surpasses the pain we experience at almost any other thing, event or time in our lives. The raging is caused by a combination of utter pain, utter sorrow and utter frustration: it seems to be that God knew that our pain at moments would be too great, and provided a natural emotional solution: we experience the searing pain and then are withdrawn from it in "islands" of numbness. Sometimes this 'numbness' or 'shock' can be mistaken by onlookers for a lack of grief, or other anomaly but it is normal and expected: we could not survive the intensity of emotional pain with rest that occurs in early grief without those 'islands'. Albert Camus once authored a novel in which a man was convicted for the death of his mother, and even imprisoned because he did not show outward emotion at her funeral.³ While this was a fictional account, one of the points made was that the depths of loss are not dependent on the outward show. Even normal grief can look outlandish in the early days and weeks. The numbness is an ebb and flow against the tide of extreme pain, which allows us to cognitively come to terms with the FACT of the loss. Mothers and Fathers in the early days know cognitively that the baby has died, but they still may experience the baby as though he or she were alive or expected, as they have done for months before the loss. The ebb and flow of pain and then numbness or shock, pain and then numbness, helps the grieving parent to put the loss in perspective. Clearly one does not get "over" the death of a baby in these early days, but the first cognitive task is to come to terms with the reality and permanance of the death, a reality which no one even wanted to embrace.

Searching & Finding: Illusory, Hallucinatory & Delusional Early Events

In the process of coming to terms with the reality of the loss, many 'unreal' experiences may occur, which if they were to happen in day to day life, would truly indicate serious problems, but in the scope and report of early mourning are troubling, but perfectly normal. When parents realize they are not alone in these troubling experiences, they can rest and begin to heal. While I am a firm believer in the supernatural, and know that God is close to His own in early mourning, many of the 'troubling' experiences are cognitive and emotional 'mistakes' or 'mirages' that the mind and heart play while trying to adapt to the loss. The main principle which is at work is not getting 'rid' of the grief, but learning to live with it: not to 'get over' the pain or escape it which so many try to do but to come to a place where the work of grief can continue in the face of missing a lost infant, but the reality of the loss is faced, the place in the family is held, and the wounds begin healing in a normal path, instead of escaping the reality by intoxication, drug use, displacement, or rushes into the next pregnancy, all of which may have a momentarily anesthetizing effect, but which ultimately lead to further hurt, tragedy and loss.

"Searching for & Finding the Baby"

After the baby has died, the mind takes on the facility of 'searching' for the lost person. ⁴ The mind and heart have a sense of the child being lost, just as when a mother loses a child in a department store: without thinking, the mother begins to search in a heightened vigilance for the child until she finds them. Bowlby argues that this has a functional purpose of keeping mothers and babies together, and defenseless infants and children safe which is advantageous for the survival of a group of people. [Bowlby note] Many mothers report this process: I have heard stories of mothers who notice every baby carriage, tv baby-related ad, or any reference to hospitals, or babies after the funeral. This is a process of the mind 'finding' the 'lost' baby, even though the genuine or true object of the search is no longer available. The result is always painful: there is a fixation on the 'found' but untrue object, but it brings pain, as the heart is only satisfied for a moment and then the fact of the loss returns. While this is normally a very functional response to keeping mothers and children together for the safety and survival of both, in grief and mourning, it becomes a means of working through the loss, but provides ultimately only pain. A mother or father cannot be kept from all reminders: it is virtually impossible. They can be reassured though that it is perfectly normal.

Seeing Hearing or Feeling the Baby

Along the lines of 'finding' the baby, parents may experience momentary events of thinking or feeling or even visual or auditory stimuli of seeing, hearing or feeling the baby in some way. While only a clinical report, Dr. Glen Davidson⁵ reported that mothers who had not seen the baby in the hospital before burial or cremation often returned months later with reports of 'phantom crying'. This process is not uncommon when an amputee loses a limb: they may continue to 'feel' the limb and even attempt to stand on a leg or use an arm no longer there. It is not that they are not realistic, but rather that the experience of the limb being there is so real it overrides information about the loss. With parents who lose a child, especially those with no 'closure' or finality to the event, the parent may even report still feeling the baby move, an event which may even have some real physical stimuli behind it as the mother's body readjusts to normal size and positioning. This may be experienced even by mothers whose babies lived, but for them it is nothing more than a small cognition; to a mother losing an infant, it is devastating as each event leads first to an experience of the baby still present in some form, and then lost again as reality sets in. Likewise, a mother may hear the above-mentioned 'phantom crying': alone at night, or in an empty house for a moment there may be an experience of of hearing an infant of the deceased infant cry: however even this in early grief is a normal experience, and most mothers while sorrowing at it, realize the unreal nature of the event. The mind is a very complicated thing and under severe stress and confusion which in mourning abounds, can provide confusing, unusual and occasionally even bizarre experiences, but it is well within normal experience. While more unusual and rare, a few mothers may even report 'seeing' the baby for example in a bassinet or crib, or even a momentary hallucination. While these experiences would border even on psychosis if a real loss had not occurred, in grief they take on new meaning: they are a cognitive-emotive, 'heart' process of letting go of a great love which was expected but not requited.

Unusual Perceptions Regarding the Burial or Cremation

In other parts of this site, we have addressed the difficult experience of expectations which are taken and twisted from joy to mourning. Instead of buying new baby clothes and receiving gifts and calling relatives, parents are faced with making funeral arrangements, having memorial services and cremating or burying their newborn. It is also a grief without many memories which are so necessary to adjustment. So the fact that unusual perceptions or rather painful perceptions come up around these events is not surprizing. A funeral director once told me that he encouraged mothers to bury their infants in a warm blanket. Reason of course demands that the infant who died does not need this, but mothers do, because while it does not make sense to the logical mind, the heart is still a mother's heart and while coming to terms with the reality and finality of death, a mother may feel that the buried infant is cold. It is important to understand that almost all mothers know this is not true but in intense pain, how one feels and how one thinks or 'knows' may differ greatly. In intense pain, these feelings are troubling and painful but not psychotic or even worrisome: it is the heart's way of working out love. Parents may worry about whether the baby was actually buried or not, even having been at the funeral---again deeply disturbing perhaps to relatives but understandable in the way the mind and heart 'work out' the finality and painfulness of the death. Sometimes mothers who did not see the baby in the hospital harbor suspicions for years that their baby may have been switched or adopted: this concern is so old, it is represented in Scriptures when Solomon is called to make a decision between the real and false mother of a child who lived and one who died. Some mothers and fathers with strong religious beliefs, may in a moments agony choose cremation which they normally do not believe in, and then deeply regret it later. This is why it is so important to clearly and fully discuss the choices made at the time with a focus on possible future regrets. Regrets over cremation in one study of ours were significantly greater in relation to choices of cremation than a traditional funeral.

Many people in this society think that a little baby's death should be easy to 'get over' quickly, but nothing could be further from the truth. Mother's may visit the grave every week or every day, or feel drawn to the place where the baby was interred or cremated even in the hospital. They may cling to the people on the hospital staff, who may be the only ones around them who still verify their feelings regarding the intensity and tragedy of the loss, while well-meaning relatives and friends unwittingly say say unhelpful and often even cruel things. One mother I recall wanted to visit the neonatal intensive care unit after her child died. Many may feel this is a morbid reaction, but in the early stages of grief, it is not. If the reaction or draw to the hospital went on more and more or way too frequently after a year or two, it could indeed be considered very troubling, but not in the beginning, not in the first weeks after death.

Mothers may feel the need to 'talk' to their infants at a graveside or in church or in the nursery: this also is perfectly normal as the loss begins to settle in the heart, and should not be met with judgmental attitudes or condemnation or looks of worry, and should most certainly not be met calls for 'mental health' treatment [whatever that is] Too often, not knowing these reactions and odd feelings are common, mothers are directed to 'counselors' who have knowledge about general 'psychological' problems but not spiritual ones or loss-related ones, particularly in the Perinatal period. That can do more harm than good, as they may caution the mothers their feelings are not normal or common when they are, and start a downhill trend towards unneeded 'treatment' for a condition which does not exist and which may hide grief. Early intense pain during loss often mimics or parallels 'psychotic' or what used to be called 'neurotic' episodes, but the difference is, they are loss-related, intense but begin to go away over time, and are usually troubling but understood by the mourner to be contrary to 'facts' or the normal milieu. Comfort, listening, asking mothers and fathers to relate the order of events and small memories over and over may be far more helpful, even if repetitive than sending a mother struggling through grief to a mental health facility involuntarily.

Preoccupation with the Baby's death, or Stimuli related to Babies

As has been established so often, the division between what is normal and what is not normal often has to do not with the experience itself, but the duration, direction, exaggeration and self-perception of the phenomena. A mother or father in early grief, which can extend to a year, would be terribly abnormal if they did not show intense mourning and preoccupation with the baby's death. We think nothing of comforting a teenager for a long time who has broken up with a boyfriend or girlfriend, remembering the pain at that age, and yet we expect a young mother who has had to bury or cremate her infant to quickly get over grief and get back to life. Preoccupation with thoughts and images of the deceased are quite expected: all heaven and earth seem to the parent to have turned upside down: they waited with joy for 9 months or a little less, and then are in one cruel moment turned to the death of their child and funeral arrangements. Even though in numbness and tears most make it through the initial days of facing the baby's death and burial, what many forget is that they have spent 9 months planning for and parenting the prenatal child. The months following the death are intense and filled with emotional suffering. Some parents talk about the child a great deal, others very little. One should not make the mistake however that those who talk little of the event are any less preoccupied. Mind, body, spirit and soul go through travail to come to terms with the loss, and the preoccupation with the identity of the child and the event of the death are essential. Just as the emotions ebb and flow, so do 'cognitions': the thoughts, memories, images, dreams and ideas of the baby and what the future would have been like or will be like now, are all thoroughly forefront.

As if this is not enough, our society is bombarded with 'baby-images'. Many mothers who have just lost a baby, are at home at least for a couple of months before returning to work, or working at home. Daytime T.V. seven days a week carries commercials for diapers, photos, and other baby-related materials and products. Mothers who are trying their best to quell complex and painful feelings, are brought constantly back to the point of loss when these commercials or other reminders come up. In preoccupation, the mind is attempting a healing and reconciliation of an unbelievable phenomenon. This is certainly not true only of mothers who lose babies but also of any loss of relationship, job/vocation, or other critical life event: we do not as human beings immediately adapt to painful realities, but require time and attention to 'assimilation' and 'accomodation' of the event.⁵ Corollary to this is the Spiritual understanding of the event: most believers voice the concept that 'bad things happen to good people' and still believe in God, but few find it easy to comprehend and accept unexpected and tragic deaths. C.S. Lewis, mentioned before, noted that when after decades of living a bachelor's life he fell in love with Joy Davies and married only to find that she was dying of bone cancer, that his faith was shown to him as a 'house of cards'. Everything gone in an instant, and as Jonah bewailing the shade of a momentary vine, he went through agony not only of mourning, but of readjusting his understanding of God and suffering. Freud, an avowed atheist, also after seeing the devastation of WWI, and onslaught of Hitler's Germany towards the end of his life could no longer leave his 'world view' the same. Expecting God to right every wrong, which He often does, for one solemn terrifying moment falls apart, as He seems to abandon mourners in the dearest place in their heart, or so it seems. Preocupation with the baby, baby things, decisions which were made, other people's babies, or pregnancies, etc, are all normal and part of the painstaking reasonings and assimilation of a life turned unexpectedly in a very sad way.

Again, with most of the experiences mentioned here, if the feelings greatly intensify over time instead of becoming more and more settled, then there is a time for caution and concern, or if there are continuous thoughts of harming oneself or another, or becoming too obsessed with another person's child or pregnancy. Then distance is required. In the early months though, mothers and fathers should be allowed to reason, and settle in their hearts the baby's death without judgment. Suggestions of 'getting your mind off' the death are futile and hurtful and cannot be done. While it may seem morbid to the uninformed, it is a normal and necessary part of defining the place of the infant in the family's life. Understanding is helpful, and again as with memories, it is helpful to allow parents to tell their story and talk about their infants without condemnation. If their pain and preoccupation is unbearable to some, then they should not be the ones called to help.

Anniversary Reactions, Events, Holiday Reactions

These have been discussed elsewhere in the site, but they bear mentioning once again regarding 'normalcy'. Marker points in grief come with reminders and may often bring back sharp reactions and emotions which mourners think they have dealt with and settled in their heart. Events such as another child's birth, a relative's pregnancy, a trip back to the hospital where the infant was born and died or even the first post-death visit to a store may bring intense unexpected reactions, perfectly normal but causing concern in onlookers. Anniversary reactions while named for the 'anniversary' of the baby's death, but also can refer to events related to the child or the death. These events often bring back grief feelings which surprise the bereaved person. The date the child was born and died is certainly foremost among these experiences. The re-swelling of emotions and feelings of intense loss are re-triggered by the year marker point, but also by other 'anniversaries' such dates when the pregnancy was diagnosed, dates when problems were diagnosed, dates of the funeral and so on. One of the most difficult things to deal with which few parents will discuss are other future events often far removed from the death: these can include the first day a child would have attended school, and other 'firsts' such as graduations, first steps, and things most have forgotten about as important to the grieving parent. Adoptive parents who have surrendered a living child, often experience the same emotions, as do some who have had abortions. The shadow of a 'missing' child from a family's life continues throughout life, and though the child is not physically present, they are an everliving presence to the parent and siblings.

Coupled with anniversary Reactions are Holidays. The worst scenario is when the death occurs right before or during a holiday season, and Christmas/Chanukah is one of the most difficult times for all bereaved persons with all types of losses. The face of joyous celebrations and gift giving while a parent is torn apart from theloss of an infant is unbearable to most. Many parents for the first time in their lives, do not celebrate, do not put up trees or decorations or hold any of their usual traditions. Usually by the second or third holiday, there is some sense of a return to normal. To try to force a grieving parent to participate is not helpful--it is pouring vinegar on a wound. Either small quiet remembrances, or even allowing a parent to 'skip' the holiday is all right: not all people heal the same way. Facilitate choices. Some parents groups hold special holiday services for bereaved parents so that they may be around others who feel the same way. One service I helped with many years ago, centered around a difficult but healing 'gift-giving'. Around the time of Christmas or Chanukah, many parents feel the urge to buy a gift for the child who died, which is a normal feeling, but most parents would not admit it to those who would not understand. During this holiday service, parents bought presents for children who would have been the age of their child, to be donated to needy children. This is a healing for many parents down the road, but the first Christmas would probably prove too trying for the newly bereaved.

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