“You believe this happened because of something inside of you, because of who you are,” I said.
“Yes,” she replied, “I am flawed.”
Celeste’s expressed feelings of shame epitomize the self-blaming cycle. She loses track of herself in mazes of guilt and flagrant self-hate as she attempts to make her way in the world. Adulthood has proven tough. Shame rears its vicious head in various areas of Celeste’s life, but after losing her pregnancy, it seemed to sprout all the more. Pregnancy loss is a prime target for feelings such as these to emerge in spades. The lack of cultural discourse surely doesn’t help. Celeste felt alienated, isolated, and, most especially, ashamed by the dissolution of her pregnancy. After the loss, she found it even harder—impossibly hard—to connect with her partner, and people more generally, for fear of being fully known, since at the core of it, she believed she was bad.
Of course, there are multiple ways in which shame manifests itself post–pregnancy loss. One instance that is rarely discussed, but that I see often in my practice, is the shame that occurs when a woman does not feel sad about her miscarriage but instead experiences relief, gratefulness, or simply no profound feeling at all. While our society has long demanded those who’ve experienced pregnancy loss grieve in silence, it should be noted that the grief is also usually an expected, required component. Women should want to be pregnant. Women should want to stay pregnant. And if they either cannot become pregnant or cannot stay pregnant, they should mourn the loss of this so-called vital cornerstone of womanhood. At least, that’s what we’re told.
For Marta, a thirty-three-year-old newlywed, it was the guilt of not feeling sad about her miscarriage she’d experienced ten years prior that brought her into my office. During the intervening years, she felt conflicted about not being conflicted. She felt a pressure, one that emanated from culture, to be attached to the idea of having a baby even though she didn’t want to have one then. Now financially stable and in a healthy relationship, she wanted to build a family—to no avail. After two losses and one failed round of IVF, she began to wonder if her feelings of relief about her lost pregnancy a decade earlier had come back to haunt her. Were her struggles to conceive “karmic retribution,” she speculated aloud to me, for being grateful her body had saved her a trip to the local Planned Parenthood, where she had intended to have an abortion? Was her current plight a divine decree, proof from a force far greater than her that there was something innately wrong with her for not wanting to carry a pregnancy to term all those years ago? Not being able to get pregnant now, her mind led her to rewrite a narrative she felt comfortable with up until this point. Now, with a wanted pregnancy seemingly unattainable, she searched for meaning in past events and assigned retaliation where there was none.
“Maybe if I had felt badly then I would be pregnant now,” she said, unable to control her tears as they carved rivers down her face. “But I didn’t feel badly then. And I don’t feel badly about it now. I really don’t. The truth is: I was so relieved that my body knew what my mind had figured out instantly—I wasn’t ready to be a mom. And now that I am ready, this happens? This feels like a twisted joke. This feels like a punishment.”
The idea that a miscarriage is a punishment for a past “misdeed” is common. The loss happened because the woman ate something. Lifted something heavy. Went to work. Slept on her right side. Slept on her left. Historically felt mixed feelings about becoming a mother. And given Marta’s plans to terminate her unwanted pregnancy, it’s unlikely that she would have been spared these present-day feelings of shame and guilt if she had not had a miscarriage, but the abortion as planned.
“What do you imagine your life would have been like had you not miscarried ten years ago and carried that pregnancy to term?” I asked, shifting the focus to the undeniable aspects of Marta’s story—the valid reasons why a pregnancy, at that time, wasn’t ideal for her. And why one would be now.
She paused briefly, looking down at the tear-soaked tissue she had been fidgeting with in her lightly freckled hands. And it was then that I noticed an obvious shift in her physical demeanor. She looked back up at me and held my gaze.
“I wouldn’t be who I am today,” she said, almost defiantly. “There’s no way I would have been able to finish school or end up at the job I have now. I wouldn’t have met my husband. It’s so hard to imagine what motherhood would have been like for me then, when I was in a less than ideal relationship with someone who was as ill-prepared to become a parent. I wasn’t equipped, emotionally and otherwise, either. I wasn’t ready. I just wasn’t.”
Once Marta began trying to get pregnant and couldn’t, she eventually wondered if something about her was defective. Just like Celeste, she felt like a failure.
• • •
Attributing a miscarriage—and any response to it—to a personal character flaw or individual choice, rather than the basic comingling of chromosomes during fertilization and the profoundly unique ways in which we emotionally digest the happenings of our bodies, keeps us suspended in the past. In the absence of forgiveness and grace, understanding and ownership, self-blame and self-hatred are left to fester, causing far too many of us to relive these experiences and our responses to them over and over again. What could I have done differently? How did I let this happen? What if I had done X instead of Y, Y instead of Z? Should I have felt this way instead? And unfortunately, positioning a pregnancy loss as a moral or personal failing is something I hear about all too often in the context of both my work and my online community. This sentiment is prevalent in research as well.16
If we believe it is standard to get pregnant and stay pregnant, we are more apt to experience shame, as we believe our experience is somehow outside of the norm. If we believe there is one response to the loss of a pregnancy, and we do not embody that response, we are also more apt to experience shame, as we assume those we express our feelings to will judge us for not living up to society’s expectations. Shame isn’t just the logical conclusion, then, but actually serves to reignite silence and stigma. It encourages a sense that we, alone, are feeling this way. Why share it with others? Why reveal ourselves to be vulnerable in that way? And so, the cycle begins anew.
If shame is where the trifecta regenerates, it’s also the best entry point to begin to break the cycle apart. As Brené Brown aptly put it, the antidote to shame is empathy.17 Miscarriage means many things to many people; I wouldn’t posit that there is any one defining feeling of a pregnancy-loss experience. But the best way to make room for all those experiences, for all those individual stories, is by speaking them aloud. Free from the all-too-pervasive trifecta. We may, for example, witness a sea change if we rebel against the notion that we should keep pregnancies “secret” until the second trimester, when we are “out of the woods.” That way, we may begin to see loss as “normal” (or at least common), and in doing so, break down those often-reported feelings of alienation and isolation.18 If we know we’re not alone, suddenly we’re not so stigmatized. If we know we’re not alone, we can begin to chip away at that shame, letting it wriggle out of the isolating confines of our psyches, eventually fizzling out entirely as it languishes without a host to prey on. And if we could manage to do that, to squash shame when it threatens to overtake us, we can aim to ensure that future generations will be self-possessed when it comes to this topic. That they will know—and deeply believe—that their losses have absolutely nothing to do with something they did or didn’t do. They will not hate on themselves. Period. That’s the world I want to live in. That’s the world I’m humbly hoping to help create.
4
“I was understanding grief from a corporeal—not simply a theoretical—perspective.”
Four years before my miscarriage, Penelope sat across from me in my sunlit office, shadowed in grief. She’d been trying to get pregnant for years, and had been coming to see me for nearly all of those. Her hair changed from one radical style to another, with alternating showstopping color combos. She liked c
hange, or at least the kind that can be expressed externally. I saw her through it all. After three miscarriages and two unsuccessful IVFs, she spoke softly of her strained marriage, wringing her hands in her lap. I shifted my weight from one leg to the other, listening intently; she shifted her eyes toward the window. But no amount of diversion could hide what sat between us: my unmistakably pregnant belly.
Understandably, my patients wanted to know about my pregnancy with Liev; a third entity had entered the consultation room, altering the therapeutic dynamic. They peppered our sessions with questions like, “How do you feel?” (especially during the first trimester, when I glowed olive green) and, “Do you know if you’re having a boy or a girl?” (I didn’t). They wondered aloud how my impending motherhood would affect my work life. Some expressed concern I might not return to work. And even if I did, would I be able to see them, would I keep a similar schedule, work into the evenings like I had been? Others shared their complex and diverging feelings about returning to see me once I became a mother myself. They worried that my foray into motherhood might trigger their own loss histories so much that starting anew with another therapist might just be a less fraught route. I listened. I empathized.
My first pregnancy had come fast and was a remarkably simple time. I had no real concerns, no preoccupations. My husband and I traveled internationally, prepared our home to accommodate a third family member, and readied our careers the best we knew how. I called upon friends and family for tidbits of wisdom, hoping they would paint a candid picture of what was in store. For whatever reason, I wasn’t overly concerned about the birth, breastfeeding, or even the inevitable sleep deprivation. Until those moments actually happened, I was in a hearty state of denial about the upcoming transformation and what it might do to my lifestyle.
Before pregnancy and throughout it, I worked long days seeing patients. I love my work, and my body seemed on board with maintaining this schedule as the pregnancy progressed. Folding motherhood into my already busy clinical and writing life felt initially daunting, especially as I began to map out my maternity leave. The closer it got, however, the clearer I became about how I ideally wanted to divide my time: three very full days at work, two days at home.
And so, in that session, I was feeling strong, confident. But Penelope, in her usual thoughtful tone, expressed concern that I would lose the pregnancy and pressed me for details about my status and symptoms. “Thank you for checking in,” I’d respond. “I feel okay.” Then I’d turn the focus back to her. Together we explored the feelings my pregnant belly evoked for her: her envy of my seemingly easy go of it, her fear that my pregnancy would end badly, her fantasy that my being a specialist in reproductive health somehow made me “immune”—that “probably nothing bad would happen” to me.
My son Liev was born that winter.
• • •
Traditional psychoanalytic theories envision the therapist as a blank slate on which patients project their thoughts and fantasies, a distant expert interpreting the patient from behind an inscrutable facade. Patients’ concerns are seen as problems the doctor can “fix” through psychological suturing. Contemporary psychoanalytic viewpoints, by contrast, have given rise to a very different understanding of the therapeutic alliance, one in which the relationship itself is ultimately what’s curative. But the therapist’s quasi-anonymity remains a central tenet. Patients might inquire about a therapist’s personal life, but unless it benefits the patient’s growth to answer the question directly, the therapist usually explores what the question means to the patient.
I was originally drawn to the field of psychology as a young girl. In fact, looking back, it seems I was enacting a kind of mock group therapy with my dolls during imaginative play, ever since the fledgling age of five. I’d arrange my stuffed animals around the perimeter of my bed, all of them facing one another in a circle. I would invite the animals to share about their days, discuss books, concepts, and most especially, feelings. An interesting preview of what was to come, I suppose.
Flash forward to my late teens, early on in my college career, when I was introduced to Carol Gilligan’s groundbreaking book In a Different Voice. This revolutionary piece of writing ignited a fire in me—one that set me ablaze on a path to pursue the study and practice of psychology, with a focus on girls and women’s development. Gilligan’s work zeroed in on making women’s voices heard, in their own right and with their own integrity, for virtually the first time in social-scientific theorizing about women. Its impact was immediate and continues to this day. Her work has inspired new research, new educational initiatives, and political debate.
Gilligan believes that the field of psychology has persistently and systematically misunderstood women—their motives, their moral commitments, the course of their psychological growth, and their view of what is important in life. She set out to correct psychology’s misperceptions and refocus its views on the psychology of women. A tour de force, Gilligan’s perspective spoke to me on a fundamental level and set the stage for my vision of a career that took on these vital issues. With a passionate interest in community issues on both a minor and mass scale, I initially pursued a master’s degree in public health, with a focus on international women’s health and an aim of incorporating global perspectives on sexual and reproductive health, international health policy, pregnancy, and access to maternal healthcare. After several years of working in the field of public health locally and abroad—in Nigeria, Senegal, India, Nepal, and elsewhere—I was offered the opportunity to study directly with Carol Gilligan at Harvard University. An opportunity I couldn’t pass up.
To have the chance to study under the very person who founded the field and spearheaded research on moral development specific to women was, in no uncertain terms, a dream come true. I was giddy with excitement and gratitude over how this was all coming to fruition. It was then that I had the chance to really integrate all of my academic and career interests—merging my studies of global reproductive issues with the psychology of women and girls. After completing my doctoral degree—which ultimately granted me the opportunity to work one-on-one with the very population of women on their paths to parenthood whom I’d been interested in for decades—I started taking patients.
Over the years, my patients have asked me a variety of personal questions focusing on a number of topics: my age, my marital status, my satisfaction in my marriage, my family history, my mental-health history, even. Of course, they are curious—how could they not be?—but some have pressed more than others. Questions like these often reflect dilemmas around trust, how they experienced maternal love in their early lives, emotional intimacy, deep-seated shame, and their aspirations for brighter, more stable futures. I should say that even I am subject to these lines of thinking: I was aware that my own therapist, Valerie, had been pregnant once. She had no children, though. She’d never volunteered more than the basics, but I was curious, figuring she’d be such a devoted mother, given how warm she was in our sessions. And so, I asked. “I wanted children and was pregnant, but it didn’t work out for us,” she shared. I wanted to know more, but we left it at that.
Like Valerie, I temper my reaction based on my understanding of the individual asking the question. For some, answering directly can be incredibly helpful, even healing. For others, though, it is best to proceed with caution. I share when I think it will be helpful and decline when I don’t. The last thing I want to be is yet another person who adds to my patient’s layered, internalized shame through shutting them down. But I also don’t want to overstimulate them by disclosing information that may throw them off course in any number of ways, like comparing their lives to mine or taking up their therapy time with personal details that may create more of a disconnect than a bridge. It’s a fine line, and I see it as my job to hold their histories and their growth at the core of my decision-making. When I think that a question might lead us into areas that are not ultimately helpful, I sensitively bring us back to the here and now.
> So, when my body changed shape and my protruding belly filled the consulting room, the traditional therapeutic construct got turned on its head. Pregnancy is seen as a community event—strangers reaching for the belly, predicting the baby’s sex, and even dispensing parenting advice. A woman’s value while pregnant is reduced to the shape and size of her body, even more than normal. The intimacy of therapy provides a ripe opportunity to comment all the more, making it that much harder to escape these exchanges. Pregnancy asserts the therapist’s presence and shatters her privacy in a way that nothing else does. I had no road map for it—none of my colleagues had so much as mentioned that this might happen, particularly my colleagues who had never been put in a position remotely like this, where the inclusion of their personal lives was unavoidable. My baby bump represented different things to different patients: an active sex life, a certain relationship status, a desire to raise a family. People pondered these elements of my life aloud, especially as the weeks pushed on and my body morphed; it became a very central part of the therapy sessions. And as my patients often told me, it stimulated longings that stemmed from their own maternal lineages.
I Had a Miscarriage Page 6