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The First Year After the Loss. Dennis primarily focused on taking care of his immediate family’s needs during the first year after Susan’s death. He believed that focusing on their needs was a necessity because his wife was having difficulty coping with the loss: She was not getting out of bed and not taking care of their young children. Dennis grew concerned about his family’s welfare. While he was at work, he constantly worried about his wife and children, frequently calling his house to see if they were okay. Often, he left work early to check on his family, or asked his mother to go to his house and get Tammy out of bed.

At this point, Dennis incurred “multiple losses” because he felt like he had not only lost Susan, but had also lost his wife and the mother of his children. He was concerned that his wife would never get better. Additionally, Dennis continued to feel like he had to be the "strong” partner in his relationship because “if she was having a bad day, I couldn’t go home and have a bad day because the kids have to be taken care of.”

To be emotionally available to his family when he was home, Dennis hid his feelings about Susan’s death, and grieved primarily alone in his car. While he was in the car, he listened to music and engaged in prospective mourning. The following narrative illustrate Dennis’s prospective mourning:

Being alone in a truck for eight to nine hours a day, especially with a radio . . . and it played these sappy songs. Butterfly Kisses. I can still listen to that one. I don’t know if you know that song. It’s about a guy, a song about a guy’s daughter who’s growing up and it goes from when she was a little girl until she’s a teenager. And there’s other ones. It was hard listening to that too. And oh gosh, it was hard to be alone in a truck.

Dennis’s most prominent emotions during the first year of grieving were anger and guilt. When Dennis was asked who he felt the most angry at, he denied feeling angry at anyone in particular, “like God or my wife,” however, he later stated that he believed that his anger came from his “situation at home.” Dennis also felt “ripped off” because “we went through the whole pregnancy and now we don’t get the baby.”

Although Dennis denied feeling guilty about his loss when he was directly asked, his guilt about Susan’s death became apparent when he described his friend’s stillbirth.

Two years after Dennis lost Susan, a friend of his had a stillbirth. Dennis talked at length about how he felt that he, himself, had somehow caused his friend’s stillbirth, even though logically he knew that he could not have done so. He felt extremely guilty for his friend’s loss, suggesting that he displaced his guilt about Susan’s death onto his friend’s stillborn baby’s death. The following statements illustrate Dennis’s guilt over his friend’s stillbirth:

I felt like it was my fault, that I lost the baby because when you hear about it, normally, the average person, it’s well, a friend of mine’s brother, a buddy he works with had a loss, or a guy I went to high school with. The way I felt about it was that we lost Susan so all our circle of friends were safe. They’re safe because we lost ours. And I felt like it was my fault because they knew me. I felt like if I would have never met her, they would never lost their baby. I felt guilty about that. I felt like it was my fault, even though I knew rationally, that no it’s not my fault.

Dennis’s guilt also came in the form of regret about what he “didn’t do” for Susan. He expressed regret over not diapering her after her birth, and not dressing her for the funeral.

Beyond One Year. Although it has been three years since Susan died, her death continues to affect Dennis’s life. One way that it still affects his life is that he still engages in prospective mourning. For example, when he sees his niece, who was born four months before Susan, he is reminded of Susan and thinks, “Well, Susan would be doing that too, and Susan would be doing that. That’s what she would be doing right now. They’d be playing there, they’d be friends and playing together and fighting.” Another way that Susan’s death continues to affect Dennis’s life is that he has had more anxiety during his wife’s pregnancies that are subsequent to Susan’s death. He described Tammy’s pregnancies after Susan’s death as “sheer nine months of terror.” Because of Susan’s death, he feels like he lost his “innocence” during subsequent pregnancies because now he knows that “anything could happen.”

Dennis’s relationships with his wife, children and parents have significantly changed since Susan’s death. He believes that his marriage has strengthened and that he and Tammy are closer than they ever have been. Dennis’s attitude toward parenting has also changed. He now prefers to spend more time with his children and does not “like doing things that will take me away from my family.” Dennis repeatedly explained how he “cherishes” the time he has with his children more than before because “anything could happen to them at any time.” The following narrative reflects how Dennis “cherishes” his children more:

I cherish the time I have with my kids now. Instead of watching the news, I read them a book. Before, I put off reading them a book and now I try not to because now I know that anything could happen at any time. My son could fall down and break his neck, or the kids could get run over by a car.

A central theme for Dennis was how his relationship with his own parents has suffered since the loss. He repeatedly expressed anger toward them, especially his mother, for how they handled the death. Dennis feels that they did not validate Susan’s existence or her death. For example, Dennis told a story about how his mother had planted a garden in honor of Susan. However, a year after planting it, she told him that she was putting in a pool and that a tractor was going to go over the garden. She told Dennis that she would replant it if he wanted her too, however, she did not express any interest in replanting it herself. Then, instead of replanting the garden, she built a sidewalk over it. Dennis felt very angry and believed that his mother did not originally plant the garden “from her heart.” Instead, she planted it so that she could show it to her friends as a “poor me kinda thing.”

Throughout the interview, Dennis also talked about how his mother did not validate Susan’s existence or his feelings about her death. She would often say to him, “You need to get on with your life,” or “What does she [Susan] matter. She’s not here. She doesn’t matter. She’s not here and she’s not your child.”

Dennis described another incident about how when his father made wood cutouts of all of the grandchildren’s names, he did not cut out Susan’s name. Dennis felt upset about that incidence, stating, “That hurt. That hurt a lot.”

Dennis’s anger at his parents is best illustrated with following narrative:

I am sitting here talking to you, and I don’t like my mother at all. I mean I love my mom and my dad, but I don’t like my mom at all. Because she can be a real jerk. She was last night. Just the way she handled this whole thing. My dad is just like, it never happened. She was never born. He never talked about it. He didn’t cut out her name, didn’t make her name out of wood.

Besides his family, Dennis has found two other sources of comfort: religion and a support group. Although he did not talk about the support group during the interview, he did talk a lot about it during the phone screen. He continues to go to the support group once per month and is often a group “leader,” or “on call” for those who had a loss. In addition, he has done some public speaking at hospitals, advocating for fathers who have experienced a perinatal loss.

Dennis’s religious beliefs have also provided him with comfort. He finds comfort in believing that he will see her again as he stated, “I have faith in Christ that I will be with her again one day.” He also finds comfort because “I know she’s better off where she is.” Dennis also reported that he has gotten more religious since losing Susan, and that his “relationship with God has gotten a lot stronger.”

The Perinatal Grief Scale. Dennis completed the PGS in the beginning of the first meeting. His scores were then computed and compared to the means and standard deviations of both the total score and the subscale scores of the PGS. These means and standard deviations were found in the validation study of this instrument (Potvin, Lasker, and Toedter,1989). Dennis’s total score was 60 (see Table II), indicating that his total grief score was approximately one standard deviation below the mean. His score for the Active Grief subscale was 23, which was approximately 2 standard deviations below the mean. His Difficulty Coping score was 21, .7 of a standard deviation below the mean. On the Despair subscale, he scored a 16, which is approximately one standard deviation below the mean.

Table II.

Dennis’s Perinatal Grief Scale Scores (compared with reference group2)

 

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 Three illustrates the results of the T.A.T.; Table Four, the C.A.T.-H. These tables list each rater’s description of the themes, distress level, and defenses of Dennis’s stories to each of the cards used in the study.

Table III.

Dennis’s T.A.T. Results

Card	Rater	Themes	Distress Level	Defenses
2	1	Affiliation, Achievement	None	Severe Repression, Denial
	2	Emotional Guardedness and Resistance, Lack of Emotional Connectedness Interpersonally, Limited or Underdeveloped Fantasy Resources	Mild-Moderate	Poorly Developed Defenses, Denial, Supression, Emotional Withdrawal
	3	Girl Goes to School, Mother Watches, Brother Plows	None	Wishes to Please, Reveals Little
3BM	1	Affiliation, Nurturance	Moderate	Moderate Denial
	2	Emotional Guardedness and Resistance, Helplessness, Need for Support, Limited or Underdeveloped Fantasy Resources	Moderate	Fragile Defenses: Emotional Withdrawal, Denial, Suppression
	3	Girl Has Bad News, Car Will Not Start, Talks it Out With Friends	High	Introjection, Attachment
7GF	1	Affiliation	None	Mild
	2	Nurturance, Emotional Guardedness and Resistance, Extreme Emotional Resistance with Maternal Figures, Attempts at Pseudo Self-sufficiency.	Mild-Moderate	Denial, Fragile Defenses: Repression, Suppression, Denial
	3	Woman Read Bible To Girl Who Goes To Bed	Mild	Sublimation

 

Table IV.

Dennis’s C.A.T.-H Results

Card	Rater	Themes	Distress Level	Defenses
3	1	Affiliation, Nurturance	None	Moderate Repression Of Denial
	2	Emotional Guardedness and Resistance, Passive-Dependent Emotional Orientation, Strong, Unresolved Need for Nurturance	Moderate	Rigid, but Fragile Defenses: Denial, Supression, Compartmentalization
	3	Father “Should Be” Playing with Boy, “Trying to Relax,” Goes Down and Has Dinner	Low-Moderate	Isolation
5	1	Affiliation, Nurturance	None	Severe Denial and Repression
	2	Abandonment by Maternal Figure, Fears of Lonliness and Isolation, Tendencies to Distort Reality	Moderate	Fragile Defenses: Denial, Suppression, Distortion
	3	Little Boys Take Naps, Mother Does Housework, She Will Take Care of Them	Mild	Suppression
9	1	Affiliation, Nurturance	None	Moderate Denial and Repression
	2	Fears of Abandonment and Rejection, Very Strong Need for Nurturance, Fairly Strong Regressive Tendencies	(None Given)	Less Adequate Defenses: Denial, Isolation, Retreat Into Fantasy
	3	Father Will Pick Up Lonely Child and Carry Him Around Until He Goes to Work	Mild	Attachment

Brief Commentary on Dennis’s Results

Dennis’s interview, PGS, T.A.T., and C.A.T.-H had conflicting results. During his interview he described having great difficulty with his loss; however, his PGS scores, T.A.T., and C.A.T.-H did not indicate a sense of grief and loss. 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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