Grief as a normative phenomenon: The diffuse and ambivalent normativity of infant loss and parental grieving in contemporary Western culture

Abstract

Grief is often conceived in causal or reactive terms, as something that simply strikes people after a loss. But, on closer scrutiny, there are good reasons to think of grief as a normative phenomenon, which is done or enacted by people, relative to cultural norms. To substantiate the claim that grief should be thought of as normative, we draw upon empirical examples from a qualitative interview study with bereaved parents following infant loss, and analyze how grieving the loss of a small child in our culture is experienced, interpreted, and enacted within a diffuse and ambivalent, yet inescapable, moral framework. Further, we discuss some of the possible consequences for bereaved individuals when navigating the normative landscape of grieving in contemporary Western cultures: A landscape in which suffering is increasingly dealt with in psychiatric and medical terms and understood as an adverse and unnecessary condition to be overcome in order to maximize personal health, happiness, and well-being.

Keywords

Grief infant death normativity parental bereavement Western cultures

Introduction

Grief is often conceived in causal or reactive terms, as something that simply strikes people after a loss, in contrast to mourning, which is typically described as “the social expressions or acts expressive of grief, which are shaped by the practices of a given society or cultural group” (Stroebe & Schut, 1998, p. 7). A standard definition, such as that provided by Gross in his textbook on grief, states for example that grief is “a universal reaction to bereavement, involving both psychological and bodily experiences” (Gross, 2016, p. 5). Grief is thus depicted in rather passive terms, as a response or reaction. Of course, there is also a more active notion of “grief work,” which is “the process by which the bereaved individual comes to terms with his/her bereavement” (p. 5), but this is typically seen as analytically separate from the grief reaction itself. For example, Attig (2004) distinguishes between grief as the “reactive agony (…) that happens to us after bereavement happens to us” and “our active response to loss” (p. 343). However, as we attempt to demonstrate in this article, the reactive responses and the active shaping of emotions and acts are deeply entangled and situated within cultural, normative practices. Hence, there are good reasons to think of grief as a normative phenomenon that not simply happens as a causally inflicted event, but which is done by people, relative to cultural norms. Grief, like mental phenomena in general, we will argue, is performed or enacted rather than passively undergone. This means that grief can be done in more or less adequate ways within local moral worlds and hence is normative (Harré, 1983).

In this article, we outline what we mean more specifically when we claim that grief should be understood in normative terms. To substantiate this claim, in the latter half of the paper we draw upon empirical examples from a qualitative interview study conducted in Denmark with bereaved parents following infant loss, and analyze how grieving the loss of an infant in contemporary Danish culture is experienced, interpreted, and enacted within a diffuse and pluralistic, yet inescapable, moral framework. Finally, we highlight and discuss some of the possible consequences for bereaved individuals when navigating the normative landscape of grieving in contemporary Western cultures.

The normativity of grief as a mental phenomenon

In their ambitious attempt to build a normative psychology (i.e., a psychological science that acknowledges the basic normativity of psychological phenomena), Harré and Moghaddam (2012) cite Kalat's introductory psychology textbook to illustrate how the normative approach differs fundamentally from the standard causal one. Kalat (2005) states that psychologists qua scientists should “act on the basis of determinism, the assumption that everything that happens has a cause, or a determinant, in the observable world” (p. 5). This, Kalat argues on the same page, is a key point of the scientific approach as such that consists of seeking the “immediate causes” of an event instead of its “final causes” (e.g., the purpose of an action). This means that the phenomena studied by psychologists—how humans think, feel, and act—should in principle be treated like all other observable events in the world (such as planets orbiting the stars or glaciers melting to form rivers). Although other textbooks use slightly different phrases, it is probably a fair verdict to conclude that something like this represents the standard approach to scientific practice in psychology (leaving aside such perspectives as phenomenology, discursive psychology, and cultural psychology).

According to Harré and Moghaddam (2012), many things are misguided about this standard causal approach. For one, they note that it (ironically) seriously misrepresents the natural sciences that it otherwise seeks to emulate. The natural sciences do not in general operate with simple Humean positivist causality (A is the cause of B if and only if there is a constant conjunction—to quote David Hume—between A-type events and B-type events), but employs models that are much more sophisticated, and which notably include references to the mechanisms or dynamic systems that mediate relationships between A- and B-type events. But even worse, the standard approach leaves out acting persons entirely, since these cannot be conceived in causal terms. If persons' acts simply happened to them causally, they could not be held accountable for their doings, and, in a sense, there would not be any acts, but only behaviors or events. And if persons' emotions simply happened mechanically in a given situation, no one could ever legitimately be blamed for exaggerated aggression or praised for suppressing an impulse to express anger.

Throughout his career as a scientific psychologist, Harré has sought to demonstrate that we can only conceivably imagine and understand psychological phenomena in the first place, because we have access to a realm of normativity. The reason why dread and anger are psychological phenomena (i.e., emotions), but not indigestion or exhaustion—although all have behavioral manifestations as well as fairly distinctive experiential qualities—is that only dread and anger fall, for us, within a moral order (Harré, 1983; see also Brinkmann, 2011). Harré says “for us,” since he believes that classifications of what does or does not belong in the normative moral order are at least partly culturally relative, which means that what counts as a psychological phenomenon likewise becomes partly culturally relative.

In one way, the normative approach to psychology is “old news” in Western thought and was thoroughly examined and articulated by Aristotle. In the Ethics, Aristotle was concerned with the human being as an intentional creature whose operations demand teleological explanation. He was concerned with the human being as a minded creature who lives in a normative space and is responsive to reasons for acting and feeling, and mental life thus cannot be grasped in a causal framework. Like Harré and Moghaddam (2012), Aristotle saw the need for a “hybrid psychology” that can integrate knowledge of the working mechanisms of the organism and its brain with knowledge of the person as an active, intentional being. For example, when he discussed motivation, he did not think that it could be fully understood by the natural scientist (the phusikos). We also need the work of the “dialectician” in order to grasp it (Robinson, 1989). For the latter “would define e.g. anger as the appetite for returning pain for pain, or something like that, while the former would define it as a boiling of the blood” (Aristotle quoted from Robinson, 1989, p. 81). The dialecticians—the cultural psychologists of the day, we might say, place anger in a normative space of reasons, and know that there is such a thing as justified anger in the face of outrageousness. What makes “boiling of the blood” (or some modern neurophysiological equivalent) anger has not just to do with its natural scientific properties, but is precisely that it is situated in a context where it makes sense to question, justify, and state the normative reason for “boiling of the blood.” Anger is thus a psychological phenomenon in so far as it is done, performed, or enacted. In other words, in so far as it is a moral phenomenon, subject to praise and blame. If it were entirely outside the realm of normativity, we should confine it instead to the science of physiology.

Similarly, to turn to the subject matter of the following analysis, grief is also on this account done or performed by skilled human actors, who can only grieve properly if they know their local moral order, i.e. know how, and how much, grief is called for in the social practices of their culture. This is not to say that grief is an action that can simply be stopped (like playing football with friends, which stops whenever the players become bored with the game or are leaving because of other appointments). But it is to say that grief should not be thought of as a purely mechanical reaction that is causally inflicted, but rather represents a normative response to a loss. The loss is not simply a cause that triggers an emotion, but is an event that provides a reason for feeling and expressing grief in a certain way. This also explains why grief (like other emotions) may be evaluated morally: The person who does not grieve sufficiently is easily seen as shallow or aloof (whether justified or not), whereas the person who is experiencing extreme grief (in a situation that does not call for deep mourning) can be accused of “overdoing it.” As we shall see below with reference to a study of parents' grief following the loss of an infant, people in such a tragic situation do not only struggle with the loss as such but also with navigating the rather unclear normativity in this situation: On the one hand, there is a cultural discourse claiming that the worst thing a human being can experience is the loss of a child, but, on the other, there is also a discourse implying (to put it bluntly) that the loss is supposed to be less intense when the child is relatively young at the time of its death, compared to older children that the parents “have gotten to know” (there is also a cultural discourse, which implies that the loss of very old persons should call for less intense forms of grief). How—and how much—should one grieve then? This is not an easy question, especially not in a Western culture with relatively diffuse norms about grief and few common rituals. In order to understand how these conditions shape parental grief after infant loss, we will now outline some of the cultural–historical changes in the normative understandings and practices specifically related to infant death and parental grief.

Historical changes in the perception of infant death and parental grief

In most Western countries prior to the late 1970s, the standard care for bereaved parents following stillbirths and perinatal losses (i.e., when an infant dies in the latter half of the pregnancy or in the first week of life) was to encourage the parents to put the loss behind them and look to the future. The dead babies were typically hid away and disposed of by the hospital staff, bereaved mothers were placed next to mothers of healthy new-born babies in the hospital ward, and any mentioning of the dead child was discouraged (Hughes & Riches, 2003; Lasker & Toedter, 1994). These practices were based on the assumption that confrontation with the loss and contact with the dead child would be harmful for the parents, reflecting the focus on “letting go” in the dominating grief models of the time (Davies, 2004).

However, inspired by the counter-cultural movement of the 1960s, grass-root associations questioning the dominating practices of care arose across several Western countries during the late 1970s and early 1980s. Bereaved parents, primarily mothers, protested against what they experienced as mechanical and emotionally oppressing practices (Hughes & Riches, 2003). These protests formed the background for the radical changes in the psychosocial management of stillbirth and perinatal bereavement that have occurred throughout the last decades in most Western countries. These movements have fought for public recognition and awareness of pregnancy and infant loss, and challenged the earlier practices of care. The change of perspective was also reflected in the publication of academic literature on parental bereavement, addressing the need for acknowledgment of the severity of the parents' loss, and claiming that lack of contact with the dead child was associated with inhibited mourning (see e.g., Lewis, 1979).

Today the model of care for bereaved parents following infant loss involves encouraging the parents to have contact with the dead child in order to create attachment and facilitate the grieving process (Davies, 2004). These new practices are associated with changes in the view on grief and bereavement, from the former focus on letting go toward understandings of grief stressing the importance of continuing bonds with the deceased (Klass, Silvermann, & Nickman, 1996).

However, in spite of these changes, cultural practices and expectations surrounding infant loss still reflect tensions and ambiguities concerning the normative practices and interpretations of the loss itself as well as the grief associated with losing small children (Cacciatore, Defrain, & Jones, 2008; Lang et al., 2011).

The British sociologist Tony Walter argues that contemporary Western grief culture is characterized by “an interplay between public provision and private experience” (Walter, 1999, p. 187). On the one hand, we see a rise in the public expression of private grief experiences (e.g., via autobiographical accounts, internet blogs, etc.), and these individual experiences have become increasingly authoritative in the professional understanding of bereavement. Simultaneously, the professional vocabulary of grief developed within the disciplines of medicine and psychology provides an interpretive framework for individuals' grief experiences. According to Walter, the notion of the “grief process” has replaced social mourning as the main regulatory framework for grief in contemporary Western societies. Walter argues: “Insofar as the self is free to define its own grief, so that there is a diversity of voices undermining any notion of a single, universal grief process, we may refer to postmodern grief. Insofar as professional expertise dominates, we may refer to late modern grief” (p. 187). In this article, we will describe the outlines of the normative landscape of parental grief as it is experienced by a group of bereaved Danish parents following infant loss, and also explore some of the consequences for these parents of grieving within the cultural framework of contemporary Danish society.

An empirical study of today's grief experiences and practices

Methodological approach

The data are drawn from 20 in-depth semi-structured qualitative interviews conducted by the first author over a period of two years (from December 2012 to October 2014) with 13 bereaved parents following infant loss. The participants—six heterosexual couples and one woman participating without her partner—were all recruited through a nationwide, private Danish organization that offers counselling and network support to bereaved parents following infant loss. With one exception (a couple participating in one interview approximately two years after the loss of their child), all participants were interviewed three times; shortly after the loss (<2 months), seven to eight months later, and finally approximately two years after the loss. With the exception of the woman participating alone, all participants were interviewed together with their partner, and all interviews were carried out in the participants' homes.

The sample of participants was selected in order to reflect the variation in terms of geographical location, circumstances of loss, family situation, and social background of the parents who ordinarily make use of the services provided by the bereavement organization. The participants had lost children who died shortly before or after (<1 week) birth, all born in the second or third trimester of pregnancy. One of the couples had lost their second child, whereas the other participants had all lost their firstborn child. The participants' age ranged from 26 to 42 years, with a mean age of 33.3 for the female participants and 31.7 for the male participants. The interview guide was developed as a semi-structured guide in order to cover the research questions for the overall project, which were formulated as follows:

How do parents experience the loss of a child, and how are these experiences related to the practices and interpretative repertoires of grief that are available in our culture?

How do the current psychological, health oriented and increasingly diagnostic understandings of grief inform individual grief experiences and practices?

How do the parents engage in and draw upon the production and negotiation of meaning, identity practices, and narratives about loss that are created within the grief support practices provided by the bereavement organization?

All interviews were audio recorded and transcribed verbatim. During the process of interview transcription and analysis, significant statements were selected and developed into tentative codes and subsequently categorized into themes developing in the data (cf. Charmaz, 2006). For the purpose of this article, we have read through the transcripts to find interview passages that directly or indirectly address the normativity of grief, i.e., statements in which the participants reflect upon their own and other people's evaluations of their loss, grief reactions, and responses. During the analytical process, the emergent findings were shared within our research group as well as with other scholars within the fields of psychology, sociology, and anthropology, who continuously have challenged and discussed our interpretations.

Findings: Diffuse status of the loss, diffuse normative framework for grieving

Numerous studies and clinical practice support the popular assumption that parents (most notably mothers) are the “chief mourners” when a child dies, and the loss of a child is generally perceived as one of the most severe types of bereavement (Robson & Walter, 2013; Sanders, 1980). Historical and anthropological studies indicate that this may be particularly pronounced in modern societies with low child mortality, compared to societies with high child mortality that have formed and still form the conditions for many people around the globe (Lofland, 1985; Scheper-Hughes, 1993). However, in contemporary Western societies with low child mortality, the loss of a small child in pregnancy or within the first weeks of life is nonetheless associated with diffuse and conflicting understandings of the magnitude and character of the loss (Cacciatore et al., 2008; Lang et al., 2011). As we have seen, earlier practices of care as well as public discourse have tended to view these losses as less severe than the loss of an older child whom one have “gotten to know.” In contrast, today the prevailing practices of care for these bereaved parents explicitly acknowledge the dead child's status as a “real child,” and encourage the parents to make bonds and create memories in order to help the grieving process (Callister, 2006). These two views represent contrasting, yet coexisting views of the loss these parents experience. Bluntly put, the former represents the loss as a more or less replaceable loss of a “foetus,” “stillborn,” “miscarriage,” or “unknown child,” while the latter promotes an image of the child as unique and irreplaceable. As we shall see, these opposing views are reflected in several ways in the participating parents' accounts.

The blurred status of the child in early infant loss

Even though most of the participating parents in this study express that they have been met with support and sympathy for their loss, most of them also refer to situations in which their loss have been met with comments which they have experienced as diminishing, inappropriate, or offensive, such as “It was good it happened now instead of later,” “It is good you didn't get to know him/her first,” etc., implying that the loss of a smaller child is somehow replaceable and hence less severe than if the child had been older. For example, Linda,¹ whose firstborn child died four days after he was born due to an unrecognized congenital disease, recalls from their son's funeral:

Then one of Chris' [her husband's] parents' friends came over, exclaiming ‘You'll just have to get back in the saddle!’ My son lies in the coffin, and we're on our way to bury him!

Likewise, Paul, who lost his firstborn child in a stillbirth, recalls:

We’ve gotten some weird comments from people, like ‘You're young, you can have another one.' I understand what's meant, but it's not like a pair of trousers. The woman who said so has three children of her own. If she lost one of them, that [having two other children] would not make her grief less.

However, even though most of the participants explicitly reject the notion that their grief is relative to the age of their child, at other times they seem to accept that there is indeed a difference. For example Mia, who also lost her firstborn child in a stillbirth, puts it this way:

Mia: I feared to be put in a [grief support] group with someone who had lost a two-year-old child. Grief cannot be compared, but that must be so awful. I'd feel that our loss is nothing compared to that…

In spite of stating that grief “cannot be compared”—an expression that is often used throughout the different interviews—Mia does actually compare her loss with others and finds her own to be less significant than someone who has lost older children. In this sense, there seems to be an unofficial “grief hierarchy” that is both rejected (“grief cannot be compared”) and accepted (“our loss is nothing compared to that”). This is an indication of what might be called normative ambivalence.

Sarah, who lost her daughter in a stillbirth, reflects on the issue of social recognition of the loss being dependent on other people's ability to relate to the child as a unique person; as someone one has “gotten to know”:

Sarah: I think it makes a difference for people that they didn't get to know her. I think the understanding would have been greater if she had lived for some months. (…) [But] it's not just an abortion. You don't just move on…

The subject of the dead child's individual and human status can be a sensitive matter. When John and Emma, who lost their second child in a stillbirth, think back to the time after their son's birth, John recalls how the midwives:

play a crucial part in making us conceive of him as our child. At first it was just a failed pregnancy—an abortion or something like that…

His wife Emma interrupts him, stating:

It's you who think like that, I don't.

John: No, okay—(they both laugh a little) That's okay. (…) But I think the way these midwives act… (…) After the birth, they say ‘Congratulations with your son’ and such. (…) To me that has made me think he's our son, and it was a real child. (…)

Emma bursts into tears, exclaiming: Of course he was a real human being!

Although many parents—also in the present study—react with initial shock and disbelief when confronted with the message that they are to go through a natural labor, most of them look back on the delivery and the time spent with their dying or dead baby as a precious experience. (It is necessary to stress that this applies to parents who by the time of birth knew that their baby was dead or would die soon after birth, and that the circumstances for parents who lose their children due to unanticipated events and medical failures during the course of birth will often be different.) The parents' trajectories from their initial response of shock and disbelief to their retrospective accounts of the birth as something “natural” and precious are mediated by the hospital staff's (most prominently the midwives') guidance throughout the process. For example, Thomas and Anna describe how the midwives “showed the way” to how they could be together with their dead son after the birth. Anna states:

[The midwife said] ‘You’ve had a son who is dead'. That hadn't dawned on me at all. She shows the way: ‘May I see Oliver?' She unwraps him, and then she leaves again. Kind of shows the way––‘this is how you are parents to a dead child’. It made it so natural to be with him, really. If somebody had told me they'd been with their dead child from Thursday to Monday, I would have found it macabre, but…It just made it such a natural thing. We are so happy and grateful they gave us the opportunity to give Oliver a lot of care and love – and to be attached to him. It has helped with the attachment.

Anna's reflections on how she believes she would have reacted before is an expression of the cultural expectance of stillbirths and infant death as something macabre. Several of the parents describe how they take these cultural expectations into account when considering how to share their experiences with others. The assumed limits of other people regarding how much they can tolerate hearing about the loss can pose a dilemma for the bereaved parents: While they may feel an urge to share their experiences of pride and affection for their dead children with others, they are concerned about whether other people might find this offensive, something that illustrates the normative ambivalence of grief in this context. Linda and Chris recall:

Linda: I still find it hard to look at the pictures [of him], but when I meet people, I really feel a need to show them the pictures. I am just as proud of my son, even though he's not here.

Chris: That's why it was so important to us that so many attended the funeral. It was important to tell that he was here. It was important that everybody got a picture of him on the funeral brochure.

Linda: It's the only picture of him with open eyes. We put it on the leaflet instead of on the coffin. That would be too explicit for people…

Diffuse norms about how to grieve: Grieving too much or too little

Associated with the diffuse and ambivalent understandings of the loss itself is a similar lack of clearly defined norms about how much or little grief that is called upon in the context of infant loss. The parents' accounts contain multiple experiences with uncertainty and confusion concerning their own and other people's expectations of what is understood as appropriate intensity, duration, and expression of their grief. On the one side, there is a dominating discourse against “cultivating” or “overdoing” grief, which is often associated with pathological grief reactions. For example, the participants repeatedly distinguish between “feeling sad” and “processing” versus being “stuck in,” “cultivating,” or letting grief “take over” in order to distinguish between appropriate and exaggerated grieving—illustrated below by Mia's reflections on the grief of a friend of hers, who has also lost an infant:

Her grief reactions [excessive anger and bitterness] have been my worst horror scenario. In my eyes, she became ill from it. (…) It's okay to feel sad, but the grief shouldn't take over. (…) We should process it, not cultivate it.

On the other side, there is a challenging discourse against grieving “too little,” that might be interpreted either as an expression of poor psychological coping (e.g., as repression), or as a failure to acknowledge the dead child's significance. For example, Anna reflects:

Several times I've gotten a bad consciousness about being able to sit and laugh… (…) I've doubted whether it's the right way to cope (…) Am I supposed to sit and stare and be sad and cry for twelve hours a day..?

Likewise, Linda talks about her ambivalent feelings when people praise her for “being strong”:

My first thought is: ‘Okay, do I not love my son enough?’ Then I push it aside. I know I love him.

The normative balancing between grieving “too much” and “too little” is a recurring theme in the interviews, and even though the participants frequently talk about grief reactions as something that “strikes” them, this does not mean that they deny responsibility for how they deal with their grief. For example, when Mia reflects on her moral accountability regarding how she responds to her loss, she suggests that there are grief reactions (like outbursts of anger or crying, etc.) that she cannot fully control. However, how she responds to these reactions (e.g., by being aware of her limits regarding social engagements in the time following the loss, apologizing for unrighteous behaviors etc.) is indeed her moral responsibility as she sees it:

Mia: To me there's a difference between grief reactions and conscious choices. We must have our own person with us. That's what I've feared the most. Not so much the grief reactions. All of a sudden, everybody has seen you cry. (…) But my focus has been on not changing our values or personality. (…) We fine-tune our personalities. It mustn't make us lesser persons.

In Mia's account, health and morality seem to conflate, in the sense that how one relates to and mediates one's grief reactions—and not so much the reactions per se—is crucial for evaluating the healthiness as well as the morality of the grief: Her friend's anger and bitterness are simultaneously evaluated as unhealthy and morally blameworthy grief responses, while healthy grieving is associated with personal development (“fine-tuning of their personalities”).

Discussion

In this article, we have argued first theoretically that grief cannot convincingly be accounted for in causal and reactive terms, but rather must be understood as a normative practice. Then, we gave empirical examples to explore how the status of the loss itself, as well as the cultural norms for grieving the loss of an infant, are both associated with normative ambivalence. This ambivalence is reflected in parental grief experiences and practices in several ways: The evaluations of the parents' grief responses (as well as their own evaluations and mediation of these responses) depend on the extent to which their loss is conceived of as replaceable or irreplaceable, related to or independent of how long the parents have known the child.

Parenthood in the modern West is shaped by normative ideals of unconditional love and of cherishing the individual uniqueness of one's child. Within this moral framework, each child is by definition irreplaceable and parental love and attachment should be independent of how long one has “known” the child. The American anthropologist Nancy Scheper-Hughes (1993), who has lived for decades among people in the poor regions of North Eastern Brazil, has given persuasive accounts of how cultural, material, and social conditions shape the process of parental attachment. In contemporary Western societies, a prevailing culture of individualism, combined with low child mortality rates, prenatal diagnostics, family planning patterns etc., has led to increasingly earlier and more pronounced “anthropomorphization” of infants and unborn fetuses (i.e., the attribution of developed human qualities and individual personhood). In contrast, Scheper-Hughes describes how the parents of the poor shantytowns in which she has conducted her field work, faced with the harsh realities of high infant mortality rates, are much more reluctant and slow in forming attachments and attributing human and individual qualities to their new-born babies. Under the conditions of devastating poverty and hopelessness, infant deaths are met with resigned acceptance, rather than grief, and parental attachment is only gradually developed as a child proves it is “strong enough” to live. Grief is thus shaped, not only by cultural ideals, but also in the most profound way by the material and social conditions under which human beings live their lives.

In contrast to the parents in Scheper-Hughes' study, the parents participating in the present study are shaped by a culture in which infant deaths are rare and unexpected and widely considered against “the natural order.” However, the normative ambivalence reflected in the parental accounts concerning infant loss indicates that even in this culture, anthropomorphization is a gradual and negotiated process. In spite of a cultural encouragement of early parental attachment, the personhood, human status, and irreplaceability of infants who die before, during, or shortly after birth are still culturally contested. As an effect, parental grieving following infant loss requires a constant negotiation of the significance and legitimacy of the loss itself. Related to this, the parents' grief responses are also shaped by normative ambivalence concerning what is conceived as appropriate grieving. The parents need to balance between grieving “too much” and “too little,” and both extremes can be interpreted as an expression of a disproportion between the loss itself and the grief response. Whether the balance tips in the direction of “too much” or “too little,” this can be interpreted as unhealthy, abnormal, or even explicitly immoral responses (e.g., when grieving “too little” is interpreted as a failure to appreciate the child's significance). Healthy, normal, and appropriate grieving is associated with cultural ideals of personal growth and development through “processing” the grief (allowing feelings of sadness, as long as these feelings do not “take over”).

Following Walter's argument of the interplay between public provision and private experience, individual grief practices are shaped by professional accounts of healthy versus pathological grief, while at the same time, professional accounts are also shaped by the normative practices of everyday life. Although we have outlined the contours of an ambivalent normative landscape for grief in general and parental grief in particular, current developments within our culture indicate a movement toward more fixed norms for grieving, most notably with the recent suggestions to introduce a psychiatric diagnosis for complicated or prolonged grief (American Psychiatric Association, 2013; World Health Organization, 2016). While such a diagnosis arguably will shape bereavement experiences and practices in the future, the diagnosis itself will also reflect the prevailing cultural understanding of suffering as an adverse and unnecessary condition to be overcome in order to pursuit personal health, happiness, and well-being (Kofod, 2015).

Conclusions

With reference to examples from a study of parental grief experiences following infant loss, we have attempted to demonstrate that human emotions, including grief, should be understood as normative, insofar as they are necessarily directed toward “objects” in the world in more or less culturally appropriate ways. When grief experiences become diffuse and ambivalent, this is related to cultural uncertainty regarding the status of the lost object (e.g., the human status of infants who die before, during, or shortly after birth), as well as to ambivalent norms regarding the appropriate intensity and expression of the emotion. Grieving the loss of an infant in our culture requires a constant balancing within this ambivalent normative landscape. We believe that researchers and practitioners within the area of bereavement and grief should pay more attention to the diffuse and ambivalent normativity of grief in order to understand the nature of this form of human suffering today.

Footnotes

Acknowledgements

This article forms part of the first author's PhD project on parental grief following infant loss, supported by The Danish Infant Death Association (“Landsforeningen Spædbarnsdød”). We are grateful to the organization for their financial support and helpful contribution to the realization of this project. We also want to thank our colleagues at the Diagnostic Cultures Research Project – Anders Petersen, Mikka Nielsen, Mette Toft Rønberg, and Rasmus Hoffmann Birk – for fruitful discussions and valuable feedback in the research process.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The first author's research is funded by the Danish Infant Death Association (“Landsforeningen Spædbarnsdød”) with 545.000 Danish Kroner.

Notes

Author biographies

Ester Holte Kofod is a PhD fellow in psychology at Aalborg University, Denmark. Her main research interests are in the interplay between individual experiences of suffering and sociocultural representations of illness and health. Her PhD study explores bereaved parents' experiences of infant loss, with particular focus on how sociocultural practices and expectations concerning grief mediate individual grief experiences.

Svend Brinkmann is professor of psychology in the Department of Communication and Psychology at the University of Aalborg, Denmark, where he serves as co-director of the Center for Qualitative Studies. His research is particularly concerned with philosophical, moral, and methodological issues in psychology and other human and social sciences. In recent years he has been studying the impact of psychiatric diagnoses on individuals and society and is engaged in cultural critique. He has authored numerous books on these issues, among them the international bestseller Interviews: Learning the Craft of Qualitative Research Interviewing (with Steinar Kvale).

References

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders. 5th ed, Arlington, VA: Author.

Attig

(2004). Meanings of death seen through the lens of grieving. Death Studies, 28(4), 341–360.

Brinkmann

(2011). Psychology as a moral science: Perspectives on normativity, New York, NY: Springer.

Cacciatore

DeFrain

Jones

K. L.

(2008). When a baby dies: Ambiguity and stillbirth. Marriage & Family Review, 44(4), 439–454.

Callister

L. C.

(2006). Perinatal loss: A family perspective. The Journal of Perinatal & Neonatal Nursing, 20(3), 227–234.

Charmaz

(2006). Constructing grounded theory: A practical guide through qualitative research, London, England: Sage.

Davies

(2004). New understandings of parental grief: Literature review. Journal of Advanced Nursing, 46(5), 506–513.

Gross

(2016). Understanding grief: An introduction, London, England: Routledge.

Harré

(1983). Personal being, Oxford, England: Blackwell.

10.

Harré

Moghaddam

(2012). Psychoneurology: The program. In: Harré

Moghaddam

(Eds) Psychology for the third millenium: Integrating cultural and neuroscience perspectives, London, England: Sage, pp. 2–21.

11.

Hughes

Riches

(2003). Psychological aspects of perinatal loss. Current Opinion in Obstetrics and Gynecology, 15(2), 107–111.

12.

Kalat

J. W.

(2005). Introduction to psychology, Belmont, CA: Wadsworth Thompson Learning.

13.

Klass

Silvermann

P. R.

Nickman

S. L.

(1996). Continuing bonds—New understandings of grief, Washington, DC: Taylor & Francis.

14.

Kofod

E. H.

(2015). Grief as a border diagnosis. Ethical Human Psychology and Psychiatry, 17(2), 109–124.

15.

Lang

Fleiszer

A. R.

Duhamel

Sword

Gilbert

K. R.

Corsini-Munt

(2011). Perinatal loss and parental grief: The challenge of ambiguity and disenfranchised grief. Omega: Journal of Death and Dying, 63(2), 183–196.

16.

Lasker

J. N.

Toedter

L. J.

(1994). Satisfaction with hospital care and interventions after pregnancy loss. Death Studies, 18(1), 41–64.

17.

Lewis

(1979). Mourning by the family after a stillbirth or neonatal death. Archives of Disease in Childhood, 54(4), 303–306.

18.

Lofland

L. H.

(1985). The social shaping of emotion: The case of grief. Symbolic Interaction, 8(2), 171–190.

19.

Robinson

D. N.

(1989). Aristotle's psychology, New York, NY: Columbia University Press.

20.

Robson

Walter

(2013). Hierarchies of loss: A critique of disenfranchised grief. Omega: Journal of Death and Dying, 66(2), 97–119.

21.

Sanders

C. M.

(1980). A comparison of adult bereavement in the death of a spouse, child, and parent. Omega: Journal of Death and Dying, 10(4), 303–322.

22.

Scheper-Hughes

(1993). Death without weeping: The violence of everyday life in Brazil, Berkeley and Los Angeles, California: University of California Press.

23.

Stroebe

Schut

(1998). Culture and grief. Bereavement Care, 17(1), 7–11.

24.

Walter

(1999). On bereavement: The culture of grief, Buckingham, England: Open University Press.

25.

World Health Organization. (2016). ICD-11 beta draft (joint linearization for mortality and morbidity statistics): 7B22 prolonged grief disorder. Retrieved 18 April, 2016, from http://apps.who.int/classifications/icd11/browse/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f1183832314.