Guest Author - Carolyn Chambers Clark, RN, EdD
This article provides background information on traumatic and upsetting losses and provides suggestions for grieving, a normal process which must follow a loss so growth and acceptance of self can occur.
When is grieving most needed?
Grieving is mandatory after a traumatic or upsetting situation. A loss of a person, object, body part or pet can cause a confusing array of symptoms. Losses require a grieving process so you can move on with your life. If the decision about the loss or upsetting situation was clear and uncomplicated, there may be little aftermath. If you were talked into surgery, an abortion or an important person or pet in your life was killed, these kind of losses can lead to hours of desperation and confusion, and more grieving is needed to resolve the myriad of feelings brought forth. Losing a job, physical vigor, or ability to function can all be confusing and require grieving. Divorces, deaths and separations require grieving.
Amy, age forty-two summarized it this way,
I lost five fetuses through spontaneous miscarriage, and I had one
fetus aborted when I found it was going to be hopelessly retarded.
I grieve for the loss of normalcy in my 2 beautiful children because
they were born with developmental delays. I grieve the loss of my
parents, the loss of my job because of my health. I do not care about
wealth, but the loss of my good friend because of life situations
changing still brings tears to my eyes. I have to let go off of
all these and still find a way to love myself. If I do, I'll survive.
Abortion is a particularly traumatic situation for millions of women. Like other controversial losses, the culture allows and supports little grieving. Elective abortion can usher in years of unresolved maternal grief, yet they may be left with little assistance and less acceptance because health care providers are often in conflict or feel negative about the procedure. According to Dian Uustal, RN, MS, EdD, a clinical ethicist in private practice in East Greenwich, RI, "Postabortive women need counseling. Without it, they're burying their guilt and their grief alive," she says. "And postabortive grief can be an awesome force."
Abortion and the need to grieve
Women who've had abortions can experience many reactions including insomnia, depression, nightmares, uncontrollable weeping, hallucinations, eating disorders, and suicidal ideation and attempts. These symptoms may occur immediately after an abortion or may not blossom until later in life, at the time of planned conception, at the birth of a second child, on the anniversary of the procedure, or at some other crucial time.
Women who have abortions also have a much higher rate of sexual abuse, partner violence and rape in their histories, which could explain why many also have been diagnosed with post-traumatic stress disorder (PTSD).
The post-abortion grief response can be shocking. Gail Williams, RN, PhD, a nurse researcher and associate professor at the University of Texas Health Science Center in San Antonio found that of 83 women who had elective abortions, 93% had the procedure in their first trimester of pregnancy. Even 11 years after the procedure, most women still experienced despair, anger, social isolation, loss of control, anxiety, sleep disturbances and dependency. Williams says, "...women are given the subtle social message to move on rather than take time to mourn their pregnancy's end. They aren't given a chance to grieve and don't know how to begin the process."
The grief response of post-abortive women is poorly understood and is plagued with controversy. Grief responses can also differ depending on whether the abortion took place at 14, 19, 35, 45 or 50. Teenagers, mothers, and even grandmothers have abortions.
Although health care providers are supposed to remain neutral about women's choices, and focus on helping, they may not. (A 1999 survey in RN magazine claims 61% of the nurses who responded said they wouldn't work on an OB/GYN unit where abortions were performed.) What this means is that women who've had abortions may not be allowed to grieve in the same way women who've had surgery or other types of medical care are allowed to, and even assisted to grieve.
Because abortion remains controversial, health care providers may not take an adequate history and ask about pregnancies that have been lost. Women who've had abortions may be reluctant to share their feelings openly with anyone, including their health care providers. Williams says that women who've had abortions are so upset about having had the procedure that they can't bear to hear the word. She suggests health care providers delicately inquire by asking about any lost pregnancies.
How to Grieve Losses
There are many tools to use besides consulting a counselor to assist in grief resolution. Some of them appear below. If they don't help you resolve your feelings, seek out a counselor who is understanding and helpful. (Ask to talk to each counselor you are considering either by phone or e-mail to help you decide if you have rapport.)
Resolving your feelings is so very important. If negative feelings about an abortion aren't resolved, they will continue to affect you. You owe it to yourself, your Maker and others to progress to your highest level of functioning.
* Invite the sacred.
Sit comfortably, and exhale, emptying yourself of confusion. Breathe in trust. Do this until you feel at full of trust.
Look intently, while continuing to breathe, at something intricate and beautiful---a shell, a stone, a flower, a candle flame, or a landscape.
Occupy your mind with the word "peace," or "calm." Feel free to choose your own word.
Follow the passage of air through your nose, to your lungs, and out your mouth in peaceful breaths.
Invite the sacred to be with you.
* Make a commitment to heal
Rituals are the way we formalize and set aside significant events. Recite or write the following commitment.
I-(your name-, solemnly promise to heal from the sorrow that is afflicting me. I will open myself to messages in my mind, dreams, visions and fantasies and faithfully record them in a special journal every day. I promise not to judge or censor what I write, but to be honest, loving and accepting of everything I learn.
* Reframe the Experience
Put the best possible interpretation, consistent with reality, on the event. What forces drove you toward the decision you made? What would allow you to forgive yourself for your action? What was learned from the event that could be used in your future? Once you have the answers to these questions, you can reframe the abortion event as understandable given the factors taking place.
* Release negative feelings
Negative feelings, especially anger and guilt, can confuse and depress you. Use one of the following methods to release negative feelings.
*Picture yourself releasing all your anger and guilt about that event. Find where it's located in your body, turn it into a liquid and let it run out of your hands and feet and flow far away, someplace where it can no longer influence you.
* When you exhale, breathe out resentment, regret, or guilt. When you breathe in, breathe in acceptance.
* Address what you regret, resent, feel guilty about, by writing or speaking about what you regret, resent or feel guilty about.
* Address what you appreciate about the event by writing or speaking about what you appreciate. (Do you appreciate that you did the best you could? Do you appreciate that you came through the experience with the potential for a new life? What else do you appreciate?)
* Address what you remember or learned, by writing or speaking about what you're grateful for.
Say good bye
When you have fully experienced the what was and are open to what will be, you have completed your grieving process. Here are some actions to help you say good bye.
* Breathe out anguish and breathe in acceptance.
* Find an object you strongly associate with that event or maybe just picture the event in your mind. If you have a picture of the lost person, animal or object, look at it, speak to it from your heart.
* Compose yourself and say whatever you wish you'd said or see yourself doing whatever you wish you'd done.
* Let the event know how it has shaped your life and how you plan to dedicate your life to supporting creativity, expression and intimacy with or in others as a result of your experience.
* If words don't come, draw your feelings. Ask yourself, How do I feel about? and draw your feelings and thoughts in broad strokes with pen, colored pencils or pens, crayons, or water paints.
* Affirm your intention to live in hope for the rest of your life.
* Find someone worse off or sponsor a family in memory of a person who you
know would want you to do this to help someone else out.
* Prepare to release the event by giving whatever blessing you choose, making
a pact with the future and repeatedly saying the word, "good bye."
* Take note of the vacancy where you once held suffering.
* Sing or play the song, "Let it Be."
* Write a Good-Bye letter to the person lost. Pour out your feelings. Start
with...Dear Loved One, If you were here right now, this is what I would
say... Keep writing until you've said everything. Include the full range of
emotions---sadness, disappointment, anger, happiness, and acceptance or
closure.
* Rest. Grieving is exhausting, but satisfying work.
* Once you're rested, resolve to consciously choose a life of hope and joy,
smiling with pleasure at the small things in life and providing service to
others.
Peace and pleasure can be yours again. Reach out for it, you deserve it!
Sources:
Ader N, David H, Major B, Roth S, Russo NJ, Wyatt G. Psychological factors in abortion: a review. Am Psychol 1992, vol 47, no. 10, pp. 1194-1204.
Farella C. The mourning after---understanding perinatal grief following abortion. Nursing Spectrum, Vol 10, no. 22FL, pp. 22-23.
Major B, Gramzow R. Abortion as stigma: cognitive and emotional implications of concealment. J Pers Soc Psychol 1999, vol 77, no. 4, pp. 735-45.
Mayo PE. The Healing Sorrow Workbook. Oakland, CA: New Harbinger Publications, Inc.
Russo NF, Zierk K. Abortion, childbearing and women's well-being. Professional Psych: Res Pract 1992, vol 23, no. 4, pp. 269-80.
Catch my e-books at Health Tips & Charts for Women
and A Perfect Body: A Holistic Plan
and Healing Vegetables
For more information, click on my other books below...they cover many topics and are listed in the following order: assertiveness, menopause, weight loss, self-care for 20 chronic conditions, integrating complementary procedures into traditional health care, encyclopedia of complementary health care practice, holistic nursing approaches to chronic conditions, group leadership, creating a climate for power learning, health & wellness promotion in communities, being a wellness practitioner
