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Chapter V: Discussion
The present investigation examined fathers’ conscious and unconscious reactions to perinatal loss. Five men who had experienced a perinatal loss in the form of a miscarriage, stillbirth, neonatal death, and/or Sudden Infant Death Syndrome (SIDS) participated in this study. They were each interviewed and administered three psychological tests: the Perinatal Grief Scale (PGS), the Thematic Apperception Test (T.A.T.), and the human form of the Children’s Apperception Test (C.A.T.-H).
This chapter aims to highlight and discuss the following: (a) the predominant themes for each participant; (b) the common themes discovered across participants; (c) the conscious versus unconscious aspects of grief experienced by the fathers; (d) the countertransference issues experienced by the researcher; (e) the clinical implications of this study; (f) the limitations of this study; and (g) and the suggestions for future research. In this chapter, the predominant psychodynamic themes for individual participants will be discussed first, integrating the results of their T.A.T., C.A.T.-H, interview, and Perinatal Grief Scale, relating these findings to the literature. As Leon’s (1990) model of perinatal loss is psychodynamic, and the only one of its kind published, it will be the primary one used in this section. Following the individual analysis, this chapter will review and discuss the common themes found across participants. For a theme to be considered common, it must have been seen in at least four of the five participants. As the main aim of this research was to examine the fathers’ both conscious and unconscious reactions of perinatal loss, the researcher has included a third section that explores these two levels of their experiences. Fourth, the researcher will describe her countertransference issues. Finally, clinical implications of this study, limits of this study, and suggestions for future research will be reviewed and discussed.
Individual Analysis
Participant One: Dennis Grieving a perinatal loss is a complicated process, often involving the intensification of earlier intrapsychic conflicts (Leon, 1992b). Dennis’s intense reaction to his daughter’s stillbirth, which occurred three years prior to his interview, can be usefully understood by using a psychodynamic lens, and looking at his earlier intraspsychic processes.
One of the most prominent topics in his interviews was his extremely strong desire for children throughout his life. His desire for children is relevant to this topic of study because when a perinatal death occurs, the need for that child is not satisfied. Although it is beyond the scope of this dissertation to clarify why he had such a strong desire for children, some hypotheses will be made, based on his interview and projective tests.
An adult’s desire for children is complicated and stems from many sources. One source identified for women is her desire to satisfy the wished-for reunion with her own mother (Leon, 1990). By having an infant, a woman remembers and recreates her own mother-infant dyad; however, instead of being the helpless infant, she is now the powerful parent. By recreating this dyad, she identifies with her needy infant, satisfying her own needs for nurturance. Although this theory is based on women, it is applied to men in the present study.
Dennis’s desire for children may be rooted in his strong need for nurturance, as suggested by his projective tests. Rater two noted that, on card three of the C.A.T.-H, Dennis had a strong and unresolved need for nurturance. Similarly, card nine indicated that he had a very strong need for nurturance. Rater one noted that on cards 3BM and 7GF of the T.A.T. and on cards three, five, and nine of the C.A.T.-H, the theme of nurturance was present. These results suggest that Dennis’s strong desire for children may be related to his strong need for nurturance.
Dennis also talked at length about his strong desire to spend time with Susan after she died. As discussed in Chapter two, spending time viewing and interacting with one’s baby often helps the grieving process (Leon, 1992; Lewis, 1979). Because parents have not had the opportunity to “get to know” their baby, grieving can be difficult as there are so few memories of their baby. Interacting with the dead baby makes the baby more concrete, gives the parents memories with the baby, and validates their loss as real and genuine (Lewis, 1979).
As Dennis was not physically capable of experiencing a fetus growing inside of him, he may have had more of a need to “bond” or “get to know” Susan after her birth. Although he attended her ultrasound scan appointments and tried as much as possible to feel her kick during the pregnancy, he still could not feel her as much as a mother could. Therefore, spending a great deal of time with her after her birth may have helped him bond with her, aiding his grieving process.
Another apparent theme for Dennis was the importance of his building Susan’s casket. The importance of this can be explained in various ways. To begin, Dennis described feeling extremely helpless over her death, and stated that he wanted to do anything to make her feel better. Making a casket was something he felt he could do for her. It is likely that the reason that he built it was to cope with his overwhelming sense of helplessness. Dennis described feeling a great need to take care of Susan, in the same ways that he cared for his other children. He described making the casket as “the last thing I could do for her.” Leon (1990) reported that a mother finds closure through “. . . holding and caressing her child, perhaps providing a special blanket as a token of her enduring wish to comfort and care for her child” (p.45). Perhaps building Susan’s casket was Dennis’s way to express his strong need to care for and nurture his child “forever.”
Another explanation for Dennis’s strong need to build Susan’s casket is that it was an attempt to repair the narcissistic wound that perinatal loss created. Leon (1990) believes that creating a dead baby can be a narcissistic injury for parents. Perhaps for Dennis, making the casket was a way to finish creating something in a way that he was not able to do with Susan. Supporting this idea is the way that Dennis described the casket, with pride and great detail, giving an indication that building it may have helped his self-esteem.
Although three years had passed since Susan’s death, her loss continued to have a great impact on Dennis’s life. Several explanations can be offered for his intense reaction. First, as noted earlier in this section, Dennis’s T.A.T and C.A.T.-H results suggested that he had a strong need for nurturance. This need could be satisfied by having children. By losing Susan, he lost the opportunity to give and gain nurturance, frustrating this need. This loss may have triggered feelings from earlier in his life when his need for nurturance was unfulfilled. A second and similar reason might be explained by his projective tests. On card two of the C.A.T.-H, one rater reported that Dennis has likely felt abandoned by a maternal figure. Given that losing one’s baby can trigger feelings of abandonment from earlier in life (Leon, 1990), it is likely that Susan’s death triggered Dennis’s earlier childhood feelings of abandonment.
Possibly, Dennis’s intense reaction is rooted in not only the multiple losses he incurred (the emotional loss of his wife and Susan’s death), but also in the fact that he may not have begun grieving until the second year after Susan’s death. During the interview, Dennis talked at length about how he focused on taking care of his family because his wife was too depressed to take care of their children. At that time, he felt that he had to be “strong” for them, expressing his emotions only when he was alone in his car. Perhaps it was not until his second year that he was able to talk to others about his experience, finally facilitating his own grieving process.
Another interesting reaction was Dennis’s intense anger at his parents, especially at his mother, since Susan’s death. His reaction may be partly due to maternal abandonment feelings from earlier in his childhood. Susan’s death may have revived these experiences. When his parents, and particularly his mother, withdrew their emotional support and invalidated his experience of the loss, he may have re-experienced his earlier feelings of abandonment and betrayal. He may also have experienced these invalidating comments as another narcissistic injury, further damaging his already fragile self-esteem.
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