Clinical Social Work
Miscarriage: The Invisible Traumatic Loss By Kristin Miller, LCSW
“While there are aspects of the grief process that are universal, it is important to recognize elements that are specific to miscarriage.”
I
can still picture the scene in my head. A small casket in the distance. A sea of children, each holding tightly to a yellow balloon, making sure not to let go before the adults gave the signal. Songs were sung, tears were shed, memories were shared, and a life was honored. That life belonged to my friend Andrew who, like me, was seven years old. Though I didn’t know it then, this was the beginning of my passion for working with people who have experienced loss. While obtaining my MSW at Columbia University, I was drawn to electives about terminal illness, grief, and loss. In my 22 years as a therapist, I have had the privilege of doing grief work with countless clients. These clients have experienced the loss of children, adolescents, and adults due to a variety of causes including car accidents, homicide, suicide, cancer, HIV/AIDS, drowning, drug overdoses, heart attacks, and IPV. In recognition of October being National Pregnancy and Infant Loss Awareness Month, I would like to take the opportunity to shine a light on a specific loss that is often overlooked: miscarriage. A miscarriage is a traumatic loss, yet it is also a loss that is often invisible. This leads to “disenfranchised grief,” a term coined by Dr. Kenneth Doka, which he defines as “a loss that is
NJFOCUS •Winter 2023
not or cannot be openly acknowledged, socially sanctioned, or publicly mourned.” Disenfranchised grief is a natural emotional reaction following a loss that is not openly accepted by society. When grief is disenfranchised, others don't recognize the relationship that existed, the loss that was experienced, or the feelings of the person who experienced the loss. Familial, cultural, and societal norms impact how people grieve and also determine acceptable and unacceptable circumstances in which to grieve. Experiencing a miscarriage often involves shock and confusion. Not being able to openly grieve can be isolating and can lead to suffering in silence; moreover, it can prolong and complicate the grief process. The psychological consequences of miscarriage may have little or no outward physical manifestations which means they can easily go unrecognized by professionals, family, colleagues, and friends. Significantly, research shows that anxiety, depression, PTSD symptoms, and suicide are strongly associated with miscarriage. While there are aspects of the grief process that are universal, it is important to recognize elements that are specific to miscarriage. Many people experience miscarriage before their pregnancy is visible to others, so others may not know about the pregnancy loss. Even if others know, there is often a lack of support. There is no wake or funeral, which means grieving parents miss out on the rituals where grieving people traditionally obtain support. Once a
