J ournal of A rts & H umanities Parental Grief and Marital Issues Aftermath : A Pilot Study

The death of a child is difficult to the bereaved parents. Literature had associated the loss with marriage disruption. The issues on that the difficulties to communicate, gender-related coping mechanisms and sexual need were discussed as reasons for bereaved parents to have conflict in their relationship. However there is limited knowledge about this issue. A pilot study has been conducted among six bereaved parents. The bereaved parents were Malaysian Muslim bereaved parents. They were interviewed individually to explore the challenges or conflicts that they had experienced after the death of their child. This study revealed that there were situations which bereaved parents described as having difficulties in their relationship. However, this study also revealed that the mutual understanding and respect to each other are the most of important components for bereaved parents to maintain their relationship post-loss. This study suggested the importance of suggesting couple counselling to bereaved parents after the death of their child.


Introduction
The death of their child is seen as the most intense and prolonged than other losses (Raphael, 2004).The previous researcher had portrayed the death of a child as leaving with a painful `existential vacuum` (Frankl, 1978).The death of a child means the loss of hopes, loss of their safety in the world and loss of desire in raising a child (Wing, Burge-Callaway, Clance, & Armistead, 2001).
In order to cope with their losses, parents reported that the spouse and other significant people in their lives are the main sources of social support (Benkel, Wijk, & Molander, 2009).However, it was found that both parents might feel devastation after the death of their child and each one will cope with the loss in different ways (Doka& Davidson, 1998).Unfortunately, the inability to understand each coping mechanism has led to the marital disruption.

Parental grief
The parental grief is a long lasting and burdensome experience for many bereaved parents (Arnold & Gemma, 2008;Wing, et al., 2001).The loss is so painful and has been associated with other issues that arise after the death of a child.In general, most of the previous researchers had associated the death of a child with the physical and psychological impacts to the bereaved parents.Previous researchers found that bereaved parents, especially mothers, were at increased risk for a first psychiatric hospitalization compared to non-bereaved parents (Li, Laursen, Precht, Olsen & Mortensen, 2005).In fact, the mortality rates were reported higher among bereaved parents especially after a traumatic death such as accidents and suicide within the first 3 years after the death of their child (Li, Precht, Mortensen, & Olson, 2003).
Furthermore, there are also other impacts that have been associated with parental grief which are divorce cases, unemployment, poorer socio-economic status, living single, migration, early parental deprivation, family history of suicidal behaviour and psychopathology, poor physical health and stressful life events (Foster et al, 1999).However, this paper will only focus on the effect on the marital disruption of the bereaved parents after the death of their child.
Due to the differences of biological make up, both parents cope with the loss differently.Even though they are experiencing the same loss but they use different coping mechanism.The bereaved mothers are associated with crying and seeking for support (Carroll & Schaefer, 1994) while the bereaved fathers cover their real feelings and avoid other people (Samuelsson, Rådestad, & Segesten, 2001;Wood & Milo, 2001).As a result, the conflicts later arise.Both parents assume that they need to support each other but the difficulties to understand how they grief had eventually affected their marriage.

Parents coping mechanism after the death of their child
A meta-analysis research by Tamres, Janicki, and Helgson (2002) found that both gender coped with bereavement uniquely, influenced by their gender.Researchers have labeled these gender differences in grief "masculine" and "feminine" (Corr, Nabe, & Corr, 2000;Nolen-Hoeksema & Larson, 1999;Stinson & Lasker, 1992).A feminine grief is characterized by emotions and help seeking attitude (Martin & Doka, 2000).In addition, the feminine grief is also characterized with displaying intense affect and the needs to share the emotions with others (Staudacher, 1991).However, masculine grief is characterized as cognitive and problem solving ways of dealing loss (Martin & Doka, 2000).
It was found that, after the death of a child, the bereaved mothers are reported to have thoughts of self-harm, feelings of regret, guilt, despair and symptoms of physical distress (Barr & Cacciatore 2008, Cacciatore, 2010).In order to cope with their situation, they use varieties of coping mechanisms compared to the bereaved fathers.The bereaved mothers cried much more than fathers and more likely to write and read about loss and grief and seek out for help from other people (Schwab, 1990).They tend to seek for support from friends and family members, they cry with their friends, asking for prayer, holding partner or spouse and accepting support from their partner and spouses (Caroll & Schaefer, 1994).Therefore, it most likely to say that the bereaved mothers are able to project their feelings openly and hoping to get support from others during their grieving process.They are using the social connections to express their feelings and thoughts.
In contrast, the bereaved fathers cope with their grief behavior by avoiding themselves to talk about the death (Stinson & Lasker, 1992).Influence by the masculinity characteristics, they are expected to be decisive, strong, successful, and inexpressive (Stillion & McDowell, 2002).As a result, they had developed a grief denial behavior (Stinson & Lasker, 1992).In fact, it was found that they also use alcohol to cope with their grief (Vance, Boyle, Najman & Thearle, 1995).However, even though the bereaved fathers tend to hide their emotion but they do grief too.It was found that 29.4% fathers reported with higher grief scores after two years post loss compared to 16.7% of mothers (Stinson & Lasker, 1992).In later research by Dyregrov and Dyregrove (1999) who found that fathers' grief scores were higher than the mothers after 12 to 15 years after the loss of their child.
Nevertheless, it can be said that both gender cope with their grief differently.The bereaved mothers cope with the grief with tears and hoping that their spouses could support them by listening to their stories and share their feelings together.However, due to masculine stereotypes, the bereaved fathers cope with the grief independently.They avoid themselves from discussing about the loss and reserve their feelings to themselves.As a result, the bereaved fathers often ask "why is my wife still crying", while the mothers say "he doesn't really care" (Cordell, & Thomas, 1997).
With this assumption, the researchers had concluded that this could be a reason on marital disruption after the death of their child.Even though it is difficult to draw clear conclusions regarding the marital disruption from the previous research due to lack of methodology, difficulties in sampling and difficulties to track the divorced couples (Murphy, Johnson, Wu, Fan, & Lohan, 2003) but it is undeniable that the difficulties to understand both gender coping mechanisms can lead to conflict in their marriage.

Communication after the death of a child
After the death of a child, the communication between spouses becomes vital as spousal communication is the main source of support and comfort (Caroll& Schaefer, 1994;Kamm& Vandenberg, 2001).The communication among bereaved parents post-loss is a primary ways of meaning -making (Bosticco & Thompson, 2005;Sedney, Baker, & Gross, 1994).However, after the death of a child, communication can be difficult (Brabant, Forsyth, & McFarlain, 1995;Hastings, 2000).
Studies on spousal communication after the death of a child that involved Weterners Parents concluded that havingcomplete openness dialogues and the ability to grief together is described as good and healthy relationship (Baxter & Montgomery, 1996).However, contradicting to studies among Asians bereaved individuals which found that Asians were more reluctant to speak about their loss as they were more concerning about straining relationships, losing face, or making others overly concerned about their problems.Asian cultures restraint in expressing negative feelings or complaints is valuable both in maintaining self-esteem and group harmony (Markus & Kitayama, 1991).Asians are less likely to find support (Kim et al., 2008).

Sexual Needs after the death of a child
After the death of a child, it was found that there are difficulties in parental marital functioning (Najman, et al., 1993).In fact, Murphy, et al., (2003) had found that marital satisfaction had decreased after five years a child died especially when the death was due to traumatic death.Supported by Foster (1999) who found that, suicide families have high rates of marital disruption prior to the death and poor relationships with the other surviving children.Later, more research had been done in order to understand the association between the death of a child and marital disruption among the bereaved parents.As a result, Rosenblatt (2000) had identified that the incongruity between fathers` and mothers` ways of grieving has led to marital disruption.
In order for the bereaved parents to deal with their grief, marital intimacy is a vital component in supporting each other (Lang & Gottlieb, 1993).It was found that the bereaved fathers perceived intimacy as sexual in nature whereas the mothers could not even think about having sex at such time.
The bereaved mothers prefer to talk about the death of their child and focusing on their emotional distress than sexual satisfaction (Kachoyeanos & Selder, 1993).
Similar finding by Gottlieb (1993) who found that they were intersection needs of intimacy between parents during their grieving process.A finding from a qualitative research project by Schwab (1992), found that there were six different themes among 20 couples who experienced the death of their child within four years.The first theme was the husband`s frustration over his wife`s grief and the feeling of helplessness for not able to even ease their own pain.Second, the wives were feeling anger to their husbands, denying and avoiding their expression of the grief.Third, the couples` inability to communicate and expressing their emotion effectively after the loss.Fourth, the loss of sexual intimacy and particularly devastating to the husbands.Fifth, the fear of losing their wife due to sexual rejection.However, the final theme was the arguments over the past issues.
Therefore, it can be said that the inability for both bereaved parents to understand each coping mechanism and needs will definitely affect their marriage.As supported by Rosenblatt (2000) who concluded that the differing needs, grieving styles and coping mechanisms had led to the marital problem after the death of a child.In fact, Finkbeiner (1996) had also portrayed the marital condition after the loss as "marriages don't die with the death of a child, but often they receive an overdue burial".

Method
This pilot study involved three bereaved fathers and three bereaved mothers.They were bereaved parents who experienced the death of their child due to vehicle accidents.All of the bereaved parents are Muslim and Malay.The age of the bereaved parents ranged from 35 to 41 years old.
The bereaved parents were found through a blog which was created by the researcher.There were clear clauses that stated: 1) This study is a voluntary study.2) This study is only for academic purposes.
Initially there were 10 bereaved parents contacted, however only six has responded.They were contacted through email address that they left on the blog.The researcher had first explained the objectives of the study to the bereaved parents.They were also informed that they are free to choose if they want to participate in the study or not.They were explained of their rights to quit from the study whenever they wanted.After signing the informed consent, the bereaved parents were asked two questions related to their marital relationship after the death of their child.There were two questions asked: 1)Whatare the challenges that you had with your spouses after the death of your child?2) How was your relationship post-loss?The data was analyzed using thematic analysis.
Objective 1: To identify challenges that bereaved parents experienced with their spouses after the death of their child.
Challenges in communication: Some bereaved parents reported to have difficulties to express their feelings to their spouses.Some described the situation as impossible for them to even try to share about what they are experiencing to their spouses.A bereaved mother shared: It was difficult.When I told him that I missed my deceased son, we would quarrel.He shouted at me.It was hard.Similar to a bereaved mother, who lost her daughter in a car accident, I cannot say anything in front of him [husband].There was one time which I tried to tell him that if our daughter is still alive, she is turning three this year.Then he shouted at me and said, "stop it!Just accept it!".Then I cried.Challenges to respect differences in coping styles: Some bereaved parents reported to feel uneasy with how their spouses coped with their grief.A bereaved mother who was also a survivor of a car accident which caused the death of her son shared, I just do not understand.He said that I did not accept the loss.I do.I accept the loss.However, I need someone that I can share my feelings.He does not understand me.Man always takes things lightly.Contradict to a bereaved father who lost his son due to a car accident who described that women love to make things complicated.The bereaved father shared, Women are always like that.They love to question about everything.Do not ask why, why and why.Just accept it.Challenges to maintain the spousal relationship: Some bereaved parents agreed that maintaining their marital relationship was difficult.The bereaved parents believed that the feeling of guilty made their relationship harder.A bereaved mother shared: I know that he must be feeling more devastated and guilty because he did not forbid our son from riding the motorcycle.We did not talk to each other for almost a year.Even until now, we still feel cold to each other.
Objective 2: To investigate spousal relationship after the death of their child.
As usual: Some bereaved parents noticed no changes in their marital relationship after the death of their child.The bereaved parents believed that there was nothing they can do but to accept the loss.A bereaved father shared: The loss had happened.We cannot change anything about it.Just accept it.Our marital relationship is as usual because we believe that there is nothing we can do.Some bereaved parents agreed that the loss was difficult but they need to pretend like nothing happened.A bereaved mother shared: Yes, the loss was nothing we can compare.It was horrible.However, we need to pretend like nothing happened.Otherwise, our marital relationship will disrupt.Conflicts: Some bereaved parents noticed negative changes in their marital relationship.The bereaved parents described of having difficulties to understand each other in terms of their coping styles and communication to each other.A bereaved mother remarked: It was difficult to understand him [husband].He never cry.The only thing that he did was going out with his friends and neglected me.Similar to a statement by a bereaved father who said: I do not understand her [wife].I know that she was sad but she kept asking why, why and why.Therefore I avoided myself from having conversation with her [wife].Our relationship was terrible.Some bereaved parents reported to have fight with their spouses.A bereaved mother shared: There was a moment which I tried to talk to him [husband] about my feelings, but we had a huge fight.He almost slapped me.He felt upset, he felt like I blamed him.Closer relationship: Some bereaved parents reported to have closer spousal relationships after the death of their child.One of the reason reported by the bereaved parents was their ability to understand each other`s coping styles.A bereaved mother shared: I know he was sad.He must be feeling more devastated because he is the father.Therefore I never talk about the loss.I respect his need.He needs room and space to grief.Some bereaved parents reported that communication is not just the only ways to show support after the death of their child.The bereaved parents believed that spending time together is more important.A bereaved father shared: I understand that it was difficult to have conversation after the loss.Therefore instead of talking, the presence of my wife was more important.It gave me comfort and serene.

Discussion
This study was aimed to understand the spousal relationship and challenges that bereaved parents experienced after the death of their child.This study revealed that bereaved parents experienced challenges in communication after the loss.Literature argued that communication between spouses is the main source of getting support and comfort (Kamm & Vandenberg, 2001).However, due to the stress post-loss, communication has become a challenge to bereaved parents.This is when bereaved parents reported to have dissimilarities in the needs to talk after the death of their child.Bereaved mothers had more preference to talk about their grief.However, bereaved fathers believed that talking about their grief signified in acceptance to fate that has already determined by God.Literature had described gender as one of the factors that made bereaved parents to face challenge in their spousal relationship post-loss (Becvar, 2001;Schwab, 1996).This study supported that the dissimilarity in communication as a coping style has led to conflicts in marital relationship among bereaved parents in this study.
The other finding from this study is the challenges for bereaved parents to maintain the harmonic in the spousal relationship.Bereaved parents reported to experience frequent quarrelling and to receive cold reactions from their spouses.Even though bereaved parents believed that they need to grief together, the inability for bereaved parents to understand each coping and communication styles has created conflicts in bereaved parents` spousal relationship.Consistent with the earlier findings from literature that argued that bereaved parents may experience the lack of energy in supporting each other which eventually has led to conflicts in their marital relationship (Rando, 1991).The findings on challenges in spousal relationship suggested the importance of having professional helps to assist bereaved parents throughout their grieving journey.It is vital for the professional help providers to help bereaved parents to embrace the communication skills and to provide more understanding on gender-coping differences.This may help bereaved parents to understand to each other and at the same time help them to maintain harmonic in their spousal relationship.
Nevertheless, this study also revealed that there were bereaved parents who were able to maintain harmonic in their spousal relationship and some had strengthen their spousal relationship.This has been studied Rosenblatt (2000), who found that the death of a child may both strengthen and stress a marital relationship.In this study, the ability for bereaved parents to understand and respect to each other`s dissimilarities in grief styles helped bereaved parents to appreciate each other more.Contradict to the earlier findings, this study revealed that communication is important however it is not a key to determine bereaved parents` spousal relationship post-loss.Bereaved parents also reported to appreciate the presence and their spouses` physical touch after the death of their child.In addition, there were also bereaved parents who reported to provide time for their spouses to mourn privately.With the mutual understanding and respect, has led to strengthen their marital relationship.At this moment, it is also helpful if the professional help providers to help bereaved parents to establish their trust to each other.In other word, the professional help providers should make both bereaved parents to understand that both of them had lost their loved ones and both of them had the rights to grief in their own ways.

Couple therapy
Coping with the death of a child is never easy.Lang and Gottlieb (1993) strongly suggested that it is vital for bereaved parents to understand each difference in coping with grief as well as respect it.However in difficult situation, Martin & Doka (2000)recommended counselors in helping the bereaved parents to assist the couple to explore the similarities and differences in their grief responses.It is also important for them to understand and respect the principles of these differences.Rothery and Enns (2001)emphasized on the need to provide space and safety to one and another in order to maintaining their relationship after the death of a child.On the other hand, Staudacher (1991)first to recommend a proactive intervention, which includes helping the couple identify the factors that can influence the relationship after the death of a child.This including identifying the differences in sexual needs, the point of view on having other children, disagreement or arguments in disciplining other surviving children, the effects from the sudden violent death, the negative reactions to spouses and issues that arise after the death of a child.
Additionally, narratives can be an instrumental therapeutic tool in that they can help the parents to explain and understand the grief process (Rosenblatt, 2000).Narratives help in providing parents with information regarding what has happened and what is happening in terms of their grief.It can also help the bereaved parents to develop a healthy narrative to assist them in dealing with crisis which may arise after the death of a child.Narratives can also assist the bereaved parents to find the meaning of their loss.
Wiinamaki and Ferguson (1998) however had recommended dealing with the death of a child through Intimacy Therapy.This therapy emphasizes on creating warm and emphatic client-therapists relationship, assisting the couples to realize the connection between unmet needs in their marriage and resulting symptoms, providing education regarding the grief process on how to delivering comfort and support to each other, teaching the importance of confession and forgiveness, focuses on surviving children` needs and realizes on how it gives impact to current relationship and providing tools such as workbook and exercise to educate and provide a safe opportunity to express emotions.

Conclusion
It is vital for bereaved parents to understand the differences in coping style, needs and communication styles.Both need to understand that they are sharing the same loss and pain.It is vital for them to understand and respect the differences.They should also make effort to spend more time together.However, in more serious situation, bereaved parents should considering professional helpers such as counselors, therapists and social workers to assist them throughout their grieving journey.The ability to attend the session will help bereaved parents to understand, respect each difference, maintaining their marriage as well as their well-being.