Grieving after the experience of an abortion or miscarriage is a special kind of loss (Worden, 2002). Loss not only means the death of an individual, but can include changes in social roles, expectations, function and body image (Payne, Horn, & Relf, 1999). Abortion is largely viewed as a “socially negated loss” (Worden, 2002, p. 136) and the secrecy and stigma around abortion can leave a woman feeling isolated and unsupported. When a woman experiences an early miscarriage she may not have even announced her pregnancy; family and friends will not have known she was pregnant, so this can bring up feelings of isolation as well (Gray & Lassance, 2003). In addition, the response to an infant’s death can be heightened by the unanticipated nature of the loss (Peppers & Knapp, 1980). In the instance that the infant is the first child, the loss can be particularly disruptive, in that it can interrupt family hopes and plans (Peppers & Knapp, 1980). Considering these circumstances, a woman may not allow herself the time and space to properly grieve or her process of grieving will be stifled or obstructed (Worden, 2002). By identifying the traits and behaviours associated with normal or uncomplicated grief and framing these behaviours in the context of reproductive loss I will outline how grieving under these circumstances can lead to complicated and disenfranchised grief.
Uncomplicated grief implies the behaviours and expressions most often experienced by individuals in general, it is also sometimes called normal grief, referring to the predictability and frequency of this set of behaviours (Worden, 2002). These expressions include a range of feelings, physical sensations, thought patterns and behaviours, and manifest in the act of mourning (Payne, Horn, & Relf, 1999). These feelings are often overwhelming and can engulf an individual’s personality and ability to function normally (Stephenson, 1985).
Sadness is identified as the most common feeling in bereaved individuals (Worden, 2002). The intensity and depth of sadness from loss is often said to be indescribable; words cannot explain how profound it is (Weizman & Kamm, 1985). When this is the case, art therapy can be an ideal intervention for expressing the intense feelings that occur throughout the mourning process. The potential overwhelming nature of sadness can lead some individuals to blocking it out or repressing their emotional needs, which can lead to more complicated grief (Worden, 2002).
Payne, Horn and Relf (1999) identify anxiety as being one of the most common responses to loss. Coping with the loss and thinking about how they will manage in the future can instil fear and anxiety. Anxiety can induce feelings of restlessness and an inability to feel relaxed, this can lead to a lack of concentration and attention (Payne, Horn, & Relf, 1999).
Experiencing anger after a loss is common and for some individuals can be very confusing (Worden, 2002). Anger stems from a sense of frustration around feeling helpless about the loss, it can also be turned inwards against the self, or outwards onto others. This displacement is related to blaming, with the reasoning that if there is an individual at fault, they are responsible for the loss, and therefore the loss could have been prevented (Worden, 2002). People often feel the need to express their anger directly to the source. This expression can be particularly difficult because the anger experienced in mourning does not necessarily involve an object for confrontation (Weizman & Kamm, 1985).
Guilt is also apparent in normal grief; directed towards the self, an individual may take on the responsibility of the loss and dwell on how they could have prevented it (Weizman & Kamm, 1985). Guilty feelings can develop from the quality of the relationship the individual had with the deceased, with people believing they could have improved their relationship or given more attention to the deceased (Weizman & Kamm, 1985). In the case of a miscarriage it is natural for parents to feel responsible for their baby. Putting blame on themselves and focusing on what they could or should have done differently serves to fulfill a fantasy where everything is all right; instead it prevents the parent from accepting the reality of the situation (Weizman & Kamm, 1985).
Other feelings associated with normal grief include helplessness, numbness, yearning, loneliness and shock (Worden, 2002).
Physical sensations are also apparent in cases of uncomplicated grief. Some of the most common sensations reported in grief counselling include hollowness in the abdomen, tightness in the chest and throat, lack of energy, feelings of weakness, a sense of depersonalization and an oversensitivity to noise (Worden, 2002).
Thought patterns may emerge in the experience of uncomplicated grief. Confusion and disbelief around the reality of the loss are common in the primary stages of grieving (Worden, 2002). In the instances of a sudden death, disbelief may surface as the idea that the death must be a mistake or even a dream (Worden, 2002). Mourning is an all-consuming process that uses a tremendous amount of physical, psychological and emotional energy (Weizman & Kamm, 1985). Forgetfulness, difficulty concentrating and disordered thoughts leave many individuals feeling confused immediately following the loss as well (Worden, 2002). Obsessive thoughts about the deceased and a preoccupation with the recovery or return of this person is another experience some individuals may find themselves going through following the loss (Worden, 2002). Hallucinations and feeling a sense of presence from the deceased are other cognitive experiences one may have after a loss; these behaviours are referred to as “searching behaviour” and occur as the bereaved experiences loneliness and yearning for their loss (Weizman & Kamm, 1985, p. 66). Audio and visual hallucinations are also frequently reported by bereaved individuals; this is related to a wish for the person to still be alive and can indicate a struggle with the reality of the loss (Weizman & Kamm, 1985).
Normal grief reactions can also involve a number of specific sleep-related behaviours. One of the most common is sleep disturbances: difficulty falling asleep, staying asleep or very early awakening. Sleep disorders may also be related to fear and anxiety around dreaming and sleeping alone (Worden, 2002). Waking from sleep can feel like the initial realization of the loss every time (Weizman & Kamm, 1985).
Dreams serve as significant psychological events that represent attempts to work through conflicts and integrate or resolve the loss (Weizman & Kamm, 1985). Dreaming of the deceased is another common experience in bereaved individuals (Worden, 2002). These dreams can often offer insight to the mourning process, and where the individual is at (Worden, 2002). Underlying themes in the bereaved dreams can be useful in understanding and making sense of the loss (Worden, 2002).