Martin Gardner, El nuevo universo ambidiestro, R BA , Barcelona, 1994 7 P Ehrenfest (19 12 ), The Conceptual Foundations o f Statistical Approach

Grief is a very complex process and it may happen that the individual, who is grieving, is not grieving in a healthy way. Then complicated grief occurs and it is important for the social worker rendering crisis intervention to be aware of these complicated grief forms.

3.5.1 Chronic grief

This is a complicated form of grief characterized by the long-lasting presence of symptoms associated with intense grief (rumination, preoccupation with thoughts of the deceased, depressed mood) and the absence of apparent progress in coming to terms with the loss of a loved one (Stroebe, et al., 2005:55; Cacciatore, 2010:145). Individuals experiencing chronic grief will be preoccupied with loss orientation and no/little oscillation toward restoration orientation. In terms of social work intervention, crisis intervention would be helpful throughout intervention although a shift needs to be made towards a more task-centred approach of intervention.

3.5.2 Delayed grief

Delayed grief is characterized by a shallow grief response, often described as” business as usual”. The individual shows little or no sign of grieving early on in bereavement, and keeps on suppressing it, although he/she may do so at a later point (Stroebe, et al., 2005:55). The bereaved person is barely slowed by the loss, and only at another time, weeks or even years later, is the true grief experienced.

3.5.3 Absent grief

Absent grief is difficult to distinguish from delayed grief (Stroebe, et al., 2005:55).The individual continues with life as though nothing had happened. (This does not always indicate pathology.) In both absent and delayed grief, individuals tend to focus on the tasks of restoration exclusively and avoiding loss orientation. With these individuals it is complex to initiate any crisis-approach intervention because the individual does not see her/himself as being bereaved and experiencing a crisis. When looking at the psychosocial implications of stillbirth, the general assumption is that men especially present more with delayed or absent grief. Fraley and Shaver (1999) mentioned that although suppression of grief may be harmful for some, the extent may have been overestimated.

3.5.4 Posttraumatic stress disorder (PTSD)

This disorder occurs consequent to the experience of a trauma such as stillbirth. Individuals who have suffered extreme trauma have difficulty in controlling their anxiety and stress arousal and in keeping these emotions at a functional level. Persistent highly distressing re-experiencing is combined with persistent efforts to avoid recollections. According to Stroebe et al. (2005:55) posttraumatic stress disorder causes a disturbance of the natural oscillation process.

3.5.5 Fixated grief

Moody and Arcangel (2002:97) explain that healthy grief is a natural continuing process, although an individual can stop to rest. Fixated grief causes survivors to remain stuck at one point. They slide into an unhealthy, prolonged withdrawal.

3.5.6 Denial

The function of denial is to protect the psyche from a crisis initially too intense to absorb. Denial is seen as functional during early stages of mourning, but becomes dysfunctional if prolonged (Moody & Arcangel, 2002:98).

3.5.7 Reversibility of the loss

Most bereaved adults, according to Moody and Arcangel, (2002:103) experience moments of expectation that their loved one will return. If this continues, the grieving process becomes dysfunctional.

3.5.8 Mementos

Different authors (Callister, 2006:232; Pauw, 1991:293 & Capitulo, 2005:394) have different opinions regarding “memory making” and keeping mementos of the deceased. Moody and Archangel (2002:104) identified four types of mementos:

 Transitional objects: These objects are kept for a while. This could be flowers parents received after having a stillbirth.

 Keepsakes: These objects are preserved permanently, and could include sonar photos, hand- and footprints of the baby and a photo.

 Lifeline objects: The bereaved parents hold on to their mementos to the extent that these articles become lifeline objects and the process becomes dysfunctional.

 Rejected objects: Discarding all objects that could serve as reminders. When bereaved parents are in denial, they sometimes pack up all the baby’s clothes and will give it away or sell it. Because this is being done on impulse, the bereaved parents are filled with regret later on by doing that and long for something to show that their baby was indeed real.

3.5.9 Emotions in disguise

Moody and Arcangel (2002:111) explained that emotions can be disguised after the death of a loved one. When a stillbirth happens, the father may for instance blame the

mother for the death, because he feels guilty for not being there for her during the pregnancy.

3.5.10 Anniversary reactions

The anniversary of certain events can bring different reactions to bereaved individuals/parents, such as feelings of sadness or depression. Moody and Arcangel (2002:112) identified events like original birth date of a stillborn baby, certain milestones which were due to take place such as sitting, walking as well as following birthdays. Such anniversaries bring painful reminders even when the process of grieving is almost completed. Reactions to anniversary events can become dysfunctional if bereaved parents are in denial regarding these events or their feelings of grief are so overwhelming that they cannot function during this period.

3.5.11 Replicated loss

Previous losses are revisited with every new loss which occurs or losses are replicated. The same fears and feelings of grief are experienced again. Replicated loss is especially troublesome if the original loss was not mourned (Moody & Arcangel, 2002: 116).

3.6 CONCLUSION

This chapter presented an in-depth review of the current understanding of grief by exploring the notion that grief, loss, mourning and bereavement are terms closely related to one another. Focus was placed on factors that influence different grief reactions. The chapter then described the grief process and a description of the three different grief models, namely task-model, dual-process model and the transcendence model was given. This serves as a foundation naturally flowing to the next chapter which focuses on the psychological implications of a stillbirth on the mother, father, couple, single mother/teenager, children and grandparents/family.

CHAPTER 4

REVIEW OF THE CURRENT UNDERSTANDING OF PSYCHOSOCIAL IMPLICATIONS OF STILLBIRTH FOR A MOTHER AND HER FAMILY

4.1 INTRODUCTION

The following chapter presents a literature overview of current understandings of psychosocial implications of stillbirth for a mother and her family. This review will include information from multiple disciplines including social work, theology and psychology. The chapter will help to equip the researcher towards implementing the empirical study, where participants will be interviewed regarding their personal experience of a stillbirth.

The focus will shift to the specific grief of a mother and her family who lost a baby. Finally the different perspectives on loss will be discussed from a social work, psychological and theological viewpoint. Through this comprehensive literature review of current understanding of the psychosocial implications of stillbirth for a mother and her family, an important objective of the study is being addressed. Included will be information from the multiple disciplines cited above.