Psychological aspects of genetic counselling / edited by Alan E.H. Emery, Ian M. Pullen.

Date:
1984
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: Psychological aspects of genetic counselling / edited by Alan E.H. Emery, Ian M. Pullen. Source: Wellcome Collection.

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    EARLY INFANT LOSS 57 which is Hkely to prove fatal within weeks or months, or has a severe congenital malformation, may be accompanied by a process of adaptation to the impending loss, or 'anticipatory grieving'. This, as will be discussed in this chapter, brings both benefits and disadvantages, but for the moment it can be assumed to mitigate some aspects of the loss. Conversely, the parent who is pregnant and loses the baby early on, for example a first or second trimester loss, should not necessarily be assumed to have a less severe reaction to bereavement in proportion with the period of gestation. Far more important is the significance of the pregnancy to the mother or parents, her or their previous experience of loss and adaptation to it, previous personality and social support. Example: The wife of a doctor experienced much unexpected anguish and distress following a spontaneous miscarriage so early in pregnancy that foetal movements had not yet been felt. She and her husband were quite unprepared for the sense of loss and disappointment, 'social failure' and even hostile comment from acquaintances — 'You must have done something . . .'. This was heightened by many work-mates who were pregnant at the time. She was a stable young woman however and adapted quickly to the situation. Bereavement is now accepted as a 'Life Event' to which the majority of people adapt in an individual way, given time and adequate support, but which may in vulnerable individuals precipitate morbidity (in physical as well as psychological terms), or even mortality in some. There is now evidence that effective counselling for the bereaved prevents some of the worst morbidity and mitigates other aspects, so that psychosocial outcome can be considerably improved. The need for support and counselling should be seen in the context of the twentieth century where customary and traditional support previously derived from formal religious beliefs as well as close and supportive family networks and more social acceptance of death and funerals, are now lacking. Professionals are concerned, not to turn grieving and loss into illness, which indeed it is not, being a 'normal' process, if now less commonly encountered, but rather in our present approach to preventive medicine, to look for ways in which to prevent psychosocial morbidity and illness in the vulnerable, or potentially vulnerable, members of the population. The timing of intervention is most important. Early identification of parents or families at risk or potentially in need ofhelp will improve outcome. For this reason, parents should be assessed and kept in close touch with the counsellor or counselling team as soon as possible after the death of the baby, rather than allow a long interval to elapse before follow-up, during which difficulties may have developed and abnormal patterns entrenched, or pathological mourning established.