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Participant Three: Raymond

Background Information

Demographic Information. Raymond, a forty-four year old, Euro-American, Protestant male, participated in the present investigation. He currently works as a computer programmer, and has been married to his wife, Barbara, for seven years. Raymond’s son, Bryan, was stillborn thirteen months ago.

Recruitment Process. Raymond was recruited into this investigation after he responded to an ad in a perinatal loss support group newsletter that his wife had showed him. He called this researcher, explaining that he would like to be in the study for the purpose of “improving the knowledge” of fathers’ experiences after incurring a perinatal loss. After ensuring that he met the requirements for the study, this investigator scheduled the first meeting.

Description of the Loss. Raymond’s son, Bryan, was stillborn thirteen months ago when his wife, Barbara, was thirty-six weeks pregnant. Raymond and Barbara learned that Bryan most likely had Down’s Syndrome during a routine ultrasound test approximately two and a half months into the pregnancy. They decided that they would keep their baby, whether or not he was born with Down’s Syndrome. They were then sent to a perinatologist so that the pregnancy could be better monitored with more frequent ultrasounds. Thirty-six weeks into the pregnancy, when they were at the doctor’s office, Barbara and Raymond learned that Bryan had died. Planning to deliver the next day, they went home and tried to rest. The next morning, Raymond took Barbara to the hospital to deliver. With some of their friends, family, and two pastors there for support, the doctors induced labor, and Barbara delivered Bryan.

The Interview

The interview occurred in two sessions, each two weeks apart. The first meeting lasted about an hour and a half, while the second meeting lasted one hour. Raymond was articulate and thought through his responses carefully. Often, he gave intellectual descriptions of the loss and how he felt, rather than displaying affect.

The following several sections describe Raymond’s desire for children, feelings about Barbara’s pregnancy, initial responses to Bryan’s death, and reactions for the first thirteen months after his death. Later, sections that summarize his PGS scores and his projective test results will be presented.

Desire for Children. Raymond talked at length about his conflicting thoughts and feelings about having children. He reported that as a child, he thought about his future career in science, rather than about his future as a father. He did not think about having children until a few years ago when his wife began talking to him about it. Raymond described feeling “in the middle” about whether he wanted to have any children. In the following narrative, he describes his ambivalence about having a baby:

When we first talked about even having children at all, I was sorta ambivalent. And, you know, my approach to it was, if we had a child or children, that was fine. Several of our friends of course have them, and they are obviously happy with it and I know that I would be as well. But, on the other hand, the independence that a couple has, in quotes, “not being tied down” you know, with

children, also kind of appealed to me. So my feeling was that if we never had children, I wouldn’t be overly upset. So I was kind of right on the fence there. Raymond’s decision to have a child was largely influenced by his wife. As

Barbara’s desire to be a mother grew, Raymond began “leaning toward wanting children, as he described by stating, “What kind of pushed me over into the direction of having children was that my wife decided that she wanted children.”

Raymond’s Experiences During the Pregnancy. When Raymond first learned that Barbara was pregnant, he had “mixed feelings.” He felt happy because he knew that she “very badly” wanted to have a child as she had waited a long time because of some bouts of infertility (he did not elaborate on this process). However, a part of him still did not want a child. He had concerns about the lifestyle changes and about the financial strains associated with becoming a parent.

As Barbara’s pregnancy progressed, Raymond gradually became more excited. He carefully began to plan for Bryan’s arrival in a variety of ways. To psychologically prepare himself, he talked with Barbara about how they would handle the lifestyle changes. He also made a nursery for Bryan, decorating it and painting the furniture, and buying a variety of baby equipment. Raymond and Barbara named their baby after Raymond, using his middle name, Bryan, for the baby’s first name. Furthermore, because education was always important to Raymond, he contemplated moving to a place with a better school system so that Bryan could have a high quality education.

Raymond described himself as being very involved with the pregnancy, attending most of the ultrasound scan appointments and often feeling Bryan kick. On a daily basis, he listened to his wife’s “blow by blow” description of how Bryan was moving around in her womb.

When Raymond learned that Bryan might have Down’s Syndrome, his excitement about becoming a father dissipated. He grew extremely concerned about having a special needs child, especially because of the “social ramifications” of the mental retardation associated with Down’s Syndrome. He talked at length about how having a child with mental retardation was a “blow to my pride and my ego” because the child would never go to college or “measure up to the standards I knew I would set for my children.” Raymond was extremely disappointed about the possibility that Bryan might have Down’s Syndrome, stating “We’ve worked so hard for this and now we finally got pregnant and now look what happened.” Raymond perceived Barbara as “stronger” than he, and felt that she would have “risen” to the occasion of having a Down’s Syndrome baby; however, he did not know if he would have been able to do the same.

Initial Responses to Bryan’s Death. When Raymond first learned that Bryan had died in-utero, he experienced shock and numbness, which is illustrated by his stating, “I guess the only real feelings that I recall from that particular point was just sort of a numbing and shock. You know, it’s the last thing of course you expect to hear.”

Once the reality of Bryan’s death began to set in, Raymond primarily focused on Barbara’s well-being, rather than on his own thoughts and feelings. He was extremely concerned about how she was going to get through the delivery, and about how she was going to cope with this loss over an extended period. Raymond reported that, after learning about Bryan’s death, they went home to rest for the upcoming delivery (scheduled for the next morning) and his “protective instinct” set in. Specifically, he focused primarily on her needs, inviting one of her friends to stay over to provide support.

During the interview, Raymond did not talk much about Bryan’s actual delivery, stating only, “Except for the fact that the baby was dead, it was like a regular delivery.”

First Thirteen Months After the Loss. One of Raymond’s most prominent reactions to Bryan’s death was that of relief, as he was extremely concerned about his own ability to cope with a child that has Downs Syndrome. He reported having no “deep feelings of loss” because his feelings of relief were greater. He was not “particularly proud to admit” these feelings, and had occasionally thought that if Bryan had been a “completely healthy, normal child, ” he would have been more devastated.

Raymond expressed a variety of emotions in response to Bryan’s death. His most central feeling was that of guilt. He described feeling most guilty over his sense of relief, rather than about the fact that Bryan died. Although Raymond repeatedly denied feeling guilty about the actual death, throughout the interview he talked about how Bryan’s life was entrusted to him and how responsible he felt for his life.

Raymond also reported that he felt sad about Bryan’s death; however, when he was asked about what made him feel the most sad, he described his guilt and sense of responsibility for its occurrence.

Raymond denied feeling angry when directly asked about this emotion; however, he later described feelings of anger toward his wife’s friend on the night they found out about Bryan’s death, because the friend was not supportive of his wife. He also talked about how he felt angry with himself, like a “failure,” because he was not able to “finish the task” of having a baby.

Rather than expressing all of these emotions, Raymond hid his feelings and reported that he has no desire to talk about the loss. For the most part, he grieved alone in his car. He described himself as an “internalizer,” which he further defined as someone who has no inclination to talk about his feelings. Rather, he is “. . . one of those people who resolves it myself.” His feelings, therefore, often “manifest” when he is alone, in a car. Unfortunately, Raymond would not elaborate about how he grieved in his car.

Along with hiding his feelings, Raymond focused on being “strong” for his wife, like a “. . . rock to which she can cling when she has felt like she was drowning.” He often encouraged her to talk about her feelings about the loss with him so that she could be supported.

Raymond does not have any children; therefore, losing Bryan triggered thoughts about his own mortality. In his own words, he explained that it has “slightly brought up the notion of my mortality and the fact that I haven’t yet continued my family line.”

Although Raymond reports that he has no “deep sense of loss,” he has often engaged in prospective mourning, reflected in the following narrative:

[We think about how] Bryan would be a year old now, you know. He’d probably be doing this or you know, we’ll think about, we’ll see a child who is about that age, and this had happened all the way through, see it and think about uhm, “Gee, what would we be doing with Bryan now?”

Raymond reported that the biggest change in his life has been the change in his relationship with Barbara. He believes that the loss has brought them closer because Barbara has become “. . . less accommodating to her high-maintenance friends.”

Raymond believes that his strong social support system and some grieving rituals have helped him cope with the loss. He belongs to a church where he has a “. . . wide circle of friends and acquaintances that have been supportive.” Raymond believes that “any negative reaction that we may have had as a result of this has probably been cushioned somewhat by that [the support].” As a ritual, he and Barbara go to the cemetery and bring Bryan flowers every other week.

Barbara is currently trying to get pregnant again; however, Raymond feels extremely anxious and ambivalent over becoming a father in the future. The following narrative further illustrates his concerns:

We are trying to get pregnant again. She is back to the fertility doctor and is back on Clomid [a fertility medication]. And we’re back on the whole cycle. Trying to do it again. I still have the same concerns. They may be amplified again a little bit by the fact that neither one of us is exactly spring chickens anymore. I mean she celebrated her fortieth birthday last week and I am forty-four and you know . .. I’m concerned about if someone in their upper forties has the same ability to have patience as someone in their upper twenties does . . . That concerns me.

The Perinatal Grief Scale

Raymond completed the PGS in the beginning of the first meeting. His scores were then computed and compared to the means and standard deviations in Potvin, Lasker, and Toedter’s (1989)-validation study. Raymond’s total score was 66, indicating that his total level of grief was approximately 1.5 standard deviations below the mean. His score for the Active Grief subscale was 20, indicating that his “active” or “normal” grief was approximately 2.4 standard deviations below the mean (see Table VIII). On the Difficulty Coping subscale, Raymond scored 23, which is an about .5 standard deviation below the mean. On the Despair subscale, he scored 23, which is approximately .2 standard deviation below the mean.

Table VIII.

Raymond’s Perinatal Grief Scale Scores (compared with reference scores4)

Active Grief Difficulty Coping Despair Total Score

Raymond Mean		SD	Raymond	Mean	SD	Raymond	Mean	SD	Raymond	Mean	SD
20	39.92	8.25	23	26.97	8.25	23	24.41	7.70	66	91.31	21.16

4 The reference group scores were taken from Potvin, Lasker, and Toedter’s (1989) validation study.

The following pages contain two tables of the results of the rater’s responses to the T.A.T. and the C.A.T.-H. Table Nine illustrates the results of the T.A.T.; Table Ten, the C.A.T.-H. These tables list each rater’s description of the themes, distress level, and defenses of Raymond’s stories to each of the cards used in the study.

Table IX.

Raymond’s T.A.T. Results

Table X.

Raymond’s C.A.T.-H Results

Brief Commentary of Raymond’s Results

Raymond’s interview, PGS, T.A.T., and C.A.T.-H had some conflicting results. His PGS and interview were consistent with each other, indicating that he is not experiencing much grief or a sense of loss. His projective tests, however, revealed that he might be struggling with a sense of loss. On card 3BM of the T.A.T., rater two noted that Raymond might have potential difficulty in resolving feelings about losses. On card five of the C.A.T.-H, rater two noted that he was very sensitive to losses, and that he had the tendency to deny the emotional impact of losses. Because it is beyond the scope of this chapter to further discuss this discrepancy, these results will be discussed in greater detail in Chapter five.

 

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