Death of a child and the impact to parental grief

Adulthood is the stage in the human lifespan that captures the stages of acquiring independence from the family of origin, establishing loving relationships and having and raising children.  When adults transition into the role of spouse and parent they are not likely to attribute this meaningful time of life to crisis.  The death of a child disrupts the biological order of the lifespan and challenges a parents understanding of their world (Rogers, Floyd, Seltzer, Greenberg and Hong, 2008).

Researchers have labelled the death of a child as one of the most tragic events a parent must endure.  In a study by Sanders (1980) comparing bereavement in individuals who experienced the death of a parent, spouse and child, Sanders identified more intense grief reactions among those who survived the death of a child (as cited by Arnold and Buschman Gemma, 2008).  A child’s death impacts the parent on multiple levels; as an individual, as a partner and as a contributing member of society.  Grief is often complicated by the addition of anxiety and fatigue which impedes communication in relationships and with other members of a family (Toller and Braithwaite, 2009).   According to Emmons, Colby and Kaiser (1998) grief is often equated to the destruction of the person’s “assumptive world” (as cited by Rogers, Floyd, Seltzer, Greenberg and Hong, 2008, p. 204).  Additionally, Colin Murray Parkes (1970) defines the “assumptive world” as “represent[ing] the totality of what the individual knows or thinks he knows. It includes… our plans and our prejudices” (as cited by Tedeschi and Calhoun, 2004, p. 21).  The length of parental grief has been estimated by some to last upwards of a decade following the child’s death while other researchers acknowledge parental grief as lasting indefinitely (Rogers, Floyd, Seltzer, Greenberg and Hong, 2008).  The negative effects of prolonged grief have implications on bereaved parent’s mental and physical health well into midlife (Rogers, Floyd, Seltzer, Greenberg and Hong, 2008).  

This paper will explore the impact that the death of a child has on the mother and father as individuals and together as a couple.  It will examine how individuals use coping mechanisms and a quest for meaning to transform this crisis in adulthood into the potential for personal growth and a renewed sense of purpose for life.  For the purposes of this paper bereavement and grief will be defined.  According to Parkes and Weiss (1983) “bereavement is …encompassing the entire experience of anticipating a death, death itself and the subsequent adjustment to living” (as cited by Meert et al., 2009).  In addition, Therese Rando (1993) defines grief as “the process of experiencing the psychological, behavioural, social and physical reactions to the perception of loss” (p. 22).

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Although crisis in adulthood is inclusive of both men and women, research shows gender specific styles of grieving and coping with the death of a child.  In a study conducted with bereaved parents by Toller and Braithwaite (2009), mothers identified the need to express their grief through discussing the death and the shedding of tears.  In her book When the Bough Breaks: Forever after the Death of a Son or Daughter, author Judith Bernstein (1998) discusses women’s grief response as frequently revealing and more likely desolate.  Bernstein (1998) explains that mother’s expressive grief may be the result of the degree mothers are invested in their parental role.   Expression of emotions can be significantly difficult in a mother’s grief experience of a stillborn baby when societal support may be absent or limited due to the inability of society to recognize the birth and death as a meaningful event (Cacciatore, 2010).  Cacciatore (2010) identifies that parent’s presumption of support from family, friends and medical staff may be based in their own value and understanding of the loss which contradicts the support actually afforded them.  Additionally, Shainess (1963) challenged that childbirth that ends with the death of a baby not only has the potential to devastate a women’s self-image but also may alter how she relates herself to others (as cited by Cacciatore, 2010).  Stillbirth has been coined as the “invisible death” because very few people knew or met the child, the mother has very few keepsakes to memorialize their child and inevitably the mother may feel pressure to forget the child by their social network (Cacciatore, 2010).

 Li, Laursen, Precht, Olsen and Mortensen (2005) found that bereaved mothers, compared with nonbereaved mothers, were at much higher risk for first time inpatient psychiatric care.  The risks remained notably higher for more than five years following the death of a child (as cited by Rogers, Floyd, Seltzer, Greenberg and Hong, 2008).  In addition, Radestad et al. (1996) identified bereaved mothers of stillborn babies experience higher rates of anxiety up to three years following the death as compared to mothers who had live born children (as cited by Cacciatore, 2010).

Bereaved mothers often question their ability to be successful at motherhood following the death of a child (Cacciatore, 2010).  Children within the family unit are often impacted by the death of a baby when their parent’s grief makes them unavailable to their emotional demands (Cacciatore, 2010).  Interestingly, a study by Peterson (1994) found that the death of a baby continues to affect future generations.  In the study, adult daughters of mothers who experienced a stillbirth, reported fear during their own pregnancy, in addition to guilt, anxiety and grief in adulthood that impacted attachment with their own children (as cited by Cacciatore, 2010).

Mother’s may illicit varied strategies to cope with the death of their child.  In a study of 47 bereaved mothers, Cacciatore (2010) found that 21% acknowledged using alcohol and illegal drugs as a form of coping, while 45% of respondents reported contemplating self-harm.  All of the respondents indicated that the death of their child had considerably altered their identity (Cacciatore, 2010).

            Men and women do not always experience grief following the death of a child in the same way.  It is not uncommon for fathers to experience societal messages that encourage a traditional male role of strength that bravely supports the mother following the child’s death (Aho, Tarkka, Astedt-Kurki and Kaunonen, 2006).  Not surprisingly, these messages may explain why research has found men are more likely to deny grief or grieve in private while suppressing reactions or hiding feelings (Aho, Tarkka, Astedt-Kurki and Kaunonen, 2006). In a study of father’s reactions to infant loss, Colsen (2001) examined conscious and unconscious responses to grief.  The study showed that some fathers had pronounced grief reactions in the unconscious while denying the presence of grief consciously (as cited by Aho, Tarkka, Astedt-Kurki and Kaunonen, 2006).

            In analysis of the research, several studies have indicated that father’s use physical activity as a means to cope with grief as well as to assimilate control over their emotions (Aho, Tarkka, Astedt-Kurki and Kaunonen, 2006; Toller and Braithwaite, 2009).  In addition to feelings of physical pain, often attributed to the physicality of men’s grief, fathers identify “strong and prolonged feelings of guilt, anger and bitterness after the death of a child directed at themselves, God and caregiving personnel” (Aho, Tarkka, Astedt-Kurki and Kaunonen, 2006).  Interestingly, in a study by Barrera et al. (2009) concerning parent adjustment following the death of a child, researchers found that the father’s interviews were significantly longer than those of the mothers’.

            As indicated in the discussion surrounding maternal grief, several studies have concluded that increased alcohol consumption also contributes to the father’s grief experience (Aho, Tarkka, Astedt-Kurki and Kaunonen, 2006).  In fact, in a study by Vance et al. (1995), concerning gender differences and psychological grief reactions for bereaved parents, research found that alcohol use in parents directly after the death and up to three years following, was significantly higher than the control group who had not experienced a death (as cited by Aho, Tarkka, Astedt-Kurki and Kaunonen, 2006).

            Parents may also share common experiences of grief following the death of a child. In a study of parental adjustment six months after the death of their child, participants identified that they mourned a future without their children and that they would never see the child meet milestones such as their graduation or wedding (Barrera et al., 2009).  In addition to missing milestones these same participants reported a significant need to physically touch their children again (Barrera et al., 2009).  Some parents of children who died in the pediatric intensive care unit indicated that they needed mementos to assist them in feeling connected to their child.  Mementos ranged from a stuffed animal to a locket of the child’s hair (Meert et al, 2008).  In fact, researchers argue that the ability of the parents’ to establish a continued connection with the deceased child through the use of memories is integral to the parental experience of bereavement and coping (Barrera et al., 2009).

            In addition to continuing the bond with their deceased child, parents have additional stress in establishing commonalities and differences in grief within the marital relationship.  Meaning is derived from telling the story of the child’s death and this can be particularly difficult for bereaved parents who often feel that their social network is not receptive to talk of the death experience (Toller and Braithwaite, 2009).  Alternatively, parents may turn to one another as a means of support but this can also prove difficult since both partners are experiencing the death simultaneously (Toller and Braithwaite, 2009).  In a study by Toller and Braithwaite (2009) of bereaved parents they found that parents wanted to grieve with their spouse while concurrently indicating that they also needed space to grieve separately from their partner.  The parents in this study reported that “grieving together was difficult due to the differing ways in which they and their partners approached and even expressed grief” (Toller and Braithwaite, 2009). A fear for many bereaved spouses is the statistical relevance of divorce among bereaved parents.  Although some research indicates a higher occurrence of divorce following the death of a child, other research challenges the methodology and difficulties in tracking divorced couples in order to make concise conclusions (Rogers, Floyd, Seltzer, Greenberg and Hong, 2008).

            A more alarming finding is the evidence of depression and long term health concerns among bereaved parents.  In their study, Rogers, Floyd, Seltzer, Greenberg and Hong (2008) analyzed data from the Wisconsin Longitudinal Study (WLS) and found that bereaved parents, in midlife and on average 18 years following the death of their child, reported more symptoms of depression  and cardiovascular problems than their nonbereaved cohort.  In fact, 83% of bereaved parents in the WLS reported depression within three years of their child’s death (Rogers, Floyd, Seltzer, Greenberg and Hong, 2008).  The researchers of this study concluded that the return to employment, social and family roles may indicate full recovery following the death of a child but persistent episodes of depression and health related issues suggest internal turmoil that may not be recognized and acknowledged by friends and family (Rogers, Floyd, Seltzer, Greenberg and Hong, 2008).  Furthermore, this study showed that the ability to function was not greater with the passing of time since the death and suggested that the bereavement following the death of a child may lead to continued health concerns for decades (Rogers, Floyd, Seltzer, Greenberg and Hong, 2008).

Bereaved parents do find ways to cope and manage the grief both individually and as a couple.  Many parents indicate that surviving children provide them with a sense of purpose and parents reinvest energy into ensuring these children are learning how to cope with the death of their sibling (Barrera et al., 2009).  Barrera et al. (2009) identified the presence of surviving children at the time of death to be linked with lower instance of marital discord.   Researchers in multiple studies found that bereaved parents who did not have surviving children reported a strong desire to have another child through pregnancy, adoption or fostering (Barrera et al., 2009; Arnold and Buschman Gemma, 2008). Interestingly Videka-Sherman (1982) found evidence that parents who had a subsequent child following death were more likely to have better psychological adjustment to grief (as cited by  (Rogers, Floyd, Seltzer, Greenberg and Hong, 2008).

In the study conducted by Toller and Braithwaite (2009) the majority of bereaved parents indicated that although they experienced grief differently than their partner, they were eventually able to identify and empathize, even accept the differences.  Bereaved parents who recognized that grieving is unique to each individual and in turn gave their spouse room to grieve or engaged with others for support found that they were able to navigate the differences and maintain a healthy relationship (Toller and Braithwaite, 2009).  Although therapeutic models encourage an ability to be open and heal, Toller and Braithwaite (2009) suggest that “selective closedness” has shown evidence of health in grieving (p. 273).  In fact, nonverbal communication between spouses is possible to create connection in grieving through hand holding, physical closeness and expression through letter writing (Toller and Braithwaite, 2009).

Many parents have identified the need to redefine themselves integrating the experience of being a parent to a child who has died (Barrera et al., 2009).  Parents have described the need for their child to be validated and recognized in a societal context, given worth in order to aid them in their ability to grieve that child (Meert et al, 2009).  Of additional importance is the acceptance from family, friends and parent’s social network to allow bereaved parents to grieve in a way that is meaningful to them at their own speed and without judgement (Meert et al., 2009). Ultimately, bereaved parents incorporate a variety of support strategies to assist them in coping with the death of their child (Barrera et al., 2009).  Many bereaved parents identified an eventual revitalized purpose to life, commonly associated with a desire to give back to the community and support other bereaved parents (Barrera et al., 2009).  Following the death of a child, Calhoun and Tedeschi (2001) theorise that individuals undergo a reorganization of beliefs surrounding significance of the world and oneself. According to Calhoun and Tedeschi (2001) “posttraumatic growth” is the “positive changes in relationship to others, spirituality or philosophy of life, and sense of self that follows bereavement” (p. 344).  A study by Engelkemeyer and Marwit (2008) of bereaved parents found that parents who reported growth were also the parents who identified having a positive outlook regarding self-worth and characterised themselves as being lucky.

 The death of a child has a profound effect on the parents as individuals and as a couple that creates a crisis in their transition through adulthood.  Bereaved parents may experience negative or positive consequences of the grief experienced following their child’s death and these effects will be felt throughout the remainder of their lifespan.

A quote from one bereaved mother eloquently sums up the enormity of death on the life experience:

Death being such a major part of life is something that only those who experience it firsthand can truly attest to being at the very core of our existence.  Death changes who we are and what we feel about life entirely.  Death even steals our perception of time and how a month ending, or a year ending or the celebration of new life affects us.  Death comes in and manipulates everyone we come in contact with, while making us an alien to everyone (Ruffin, 2010, p.9).