NARRATIVE INQUIRY, / i ( l ) , 243-262 Copyright ©2003, John Benjamins B.V., Amsterdam
INFERTILE WOMEN AND THE NARRATIVE WORK OF MOURNING: BARRIERS TO THE REVISION OF AUTOBIOGRAPHIGAL NARRATIVES OF MOTHERHOOD Maggie Kirkman La Trobe University, Melbourne, Australia
Infertility can be a source of profound grief; infertile women mourn the loss of the fertile self and their desired children. Part of the work of mourning can be understood as revising the autobiographical narrative to accommodate infertility's disruption to the plot of one's life. Drawing on aspects of a qualitative analysis of the narratives of infertility told by 31 Australian women, this article suggests potential barriers to the work of revision, including cultural and social factors such as the dominance of the motherhood narrative, the absence of a collective narrative of the non-mother, and lack of audience support; as well as more personal factors such as a lack of meaningful altemative goals and the existence of hope. The complexity of the work of revision and the need for caution in encouraging premature revision is exemplified by the role of hope in dealing with the blow of infertility. {Infertility, Narrative, Grief, Involuntary Childlessness, Qualitative Research) Infertility can be a source of profound grief. Infertile women mourn the loss of the fertile self and their desired children; those who become mothers grieve the losses experienced on the way to parenthood. Part of the work of mourning can be understood as revising the autobiographical narrative in order to accommodate infertility's disruption to the plot of one's life. In this article I suggest some potential barriers to the work of revision in women who
Requests for further infonnation should be directed to Maggie Kirkman, Key Centre for Women's Health in Society, University of Melbourne, Victoria 3010, Australia. E-mail:
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have experienced infertility. I conclude by advocating the need for caution in encouraging premature autobiographical revision. My focus is on women who have experienced infertility, whether or not they have children or have used assisted reproductive technology (ART). They may mourn losses that are multiple and particularly savage for being so often invisible and unrecognised by others, who may demand a rapid resolution of grief (Kirkman, 2001b). The loss of identity as a mother, of children who exist only in the autobiographical narrative, of relationships with those children and grandchildren, of hopes and dreams of the future, of participation in the world of mothers, of acknowledgement by society as fully developed women, of a genetic future: all these losses confuse even the woman herself, because she can not point to something tangible that has gone. There may also have been miscarriages and the emotionally demanding experience of ART. Those who have fewer children than they planned and those who have achieved children only with great difficulty can still grieve for their lost fertile selves and their disrupted lives (Becker, 2000; Kirkman & Rosenthal, 1999). John Bowlby (1980, p. 18) is my source in applying the terms grief and mourning. Although they are to some extent interchangeable, mourning refers to "all the psychological processes, conscious and unconscious, that are set in train by loss". Grief is "applied to the condition of a person who is experiencing distress at loss and experiencing it in a more or less overt way." Infertility has been found to challenge one's sense of self (Becker, 2000; Downey & McKinney, 1992; Koropatnick, Daniluk, & Pattinson, 1993; Moller & Fallstrom, 1991; Monach, 1993; Olshansky, 1987). Part of the work of mourning in infertility, then, can be seen as repairing the disruption to one's autobiographical narrative, and accommodating within it the multiple losses entailed in infertility. The theory of narrative that informs this research is based on the premise that we do not live passively: We actively attempt to understand, to interpret, and to explain our lives. The way in which our lives are understood shapes the life being lived and the life to come, as we make decisions that are consistent with the plot - or plots - of our lives. Each life is understood through multiple layers of narratives, perhaps linked by a larger explanatory plot. (Following Paul Ricoeur [e.g. 1980], I take plot to be that narrative device which confers order, sequence, and meaning on a collection of oth-
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erwise isolated events. In the absence of emplotment, our lives would seem haphazard and meaningless.) When I use the term "narrative" in this context, I want to evoke that mode of thought which brings meaning to human experience by looking at context and by attempting to explain and to understand. Jerome Bruner (1986) argued for the existence of two modes of thought: not only paradigmatic reasoning, the traditional understanding of thought as logical induction, dealing in principles abstracted from context; but also the narrative mode, which takes account of context and intentions through the stories constructed to make sense of human experience. The paradigmatic mode deals in general causes, and attempts to discover empirical truth. The narrative mode "deals with the vicissitudes of human intentions" (Bruner, 1986, p. 16). It is the narrative mode of thought which I used to frame my research, taking in to account both the way that individual people understand the vicissitudes of their own lives, and the way that researchers attempt to understand the lives of others (Kirkman, 2002c). The mundane vicissitudes of life may require only negligible or gradual adjustments to our autobiographical narratives. When the plot of our life is disrupted by a major event, such as the discovery of chronic illness (Garro, 1994; Williams, 1984) or infertility, narratives are fundamentally challenged (Ezzy, 2000; Webb & Daniluk, 1999). This may be because the current explanation of life events is unsatisfactory, or because the goals which have structured the autobiographical narrative are no longer achievable. A growing literature describes the role of narratives in making sense of loss and grief (as in illness: Frank, 1995). It has been argued that narrative reconstruction can be used to rebuild the shattered sense of identity and meaning entailed in the disorder and incoherence brought about by traumatising experiences (Crossley, 2000). Some clinical psychologists understand their work as facilitating the "re-authoring of lives" by their clients (White, 1995); there is evidence that deliberate attempts to construct personal narratives can be beneficial in dealing with emotionally distressing events (Pennebaker, 2000). I was alerted to narrative revision in infertility by iterative research with women who had experienced infertility (Kirkman, 1997). The central goal of the research was to understand the role of infertility in the lives of women as they explained it, in contrast to the explanations more powerfully presented in the dominant discourses of medicine and the social sciences. Factors that appeared to contribute to revision included both maintaining and changing self
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identity; accepting a consoling plot; and attrition. The equivocal roles of both dispositional optimisnn and (apparently) insurmountable barriers to motherhood illustrate the problem of identifying contributors to revision (Kirkman, 2002b). In this article, I tum my attention to factors that appear to be implicated in the narratives of women who have not revised their autobiographical narratives once infertility has disrupted the plot.
METHOD Participants Women were sought to participate in the research who described themselves as infertile or as members of an infertile couple. The first 31 volunteers were selected; recruitment was stopped when the richness of the data became apparent. The women's ages ranged from 28 to 74 and their education from incomplete secondary school to PhD. They stated a variety of causes for their infertility, including female, male, unknown, and multiple causes. Nineteen women had no children when first interviewed; the other 12 women had become mothers without technological intervention, by adoption, or with the help of ART. (More information on the meaning of infertility and the role of ART can be found in Kirkman, 2001a; Kirkman & Rosenthal, 1999.) The research did not arise from any assumption about the essence of an experience of infertility, nor did it set out to define a population of which these volunteers would constitute a representative sample. The diversity they embodied ensured that similarities in aspects of their accounts were all the more striking. The women were investigated as individuals and not aggregated into groups. To do so would have been inappropriate. For example, some women who were childless when the research began became mothers as it continued; some women who had not used ART may have done so in other circumstances, or reserved the right to reconsider their decision (Kirkman & Rosenthal, 1999). It was impossible to make decisive and meaningful distinctions among categories of women. This complexity and the changes in their accounts over time were of interest in themselves. Because "'the-story-of-a-life' as told to a particular person is in some deep sense a joint product of the teller and the told" (Bruner, 1990, pp. 124-125), the researcher in studies of this kind inevitably participates in it. I included myself as a fonnal participant in the project under discussion because I
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fulfilled the selection criterion of infertility and because there was a chance that other participants would know something of my story through publicity given to my reproductive choices (see Kirkman, 2001a). This knowledge could obviously affect what they were prepared to reveal to me, and I took steps both to minimise and to account for my influence on the research. My participation is discussed in detail elsewhere (Kirkman, 1999a). Data Collection and Analysis To begin, I interviewed each woman for about two to three hours. Interviews took place in the State of Victoria, Australia, where all but one of the women were living. (The exception was a woman who was visiting from interstate.) I began each interview by saying, "Can you tell me the story of your infertility?" By asking for a story, I was encouraging a plot, although the women demonstrated that it was possible to ignore this implied demand. Transcriptions of the interviews were revised in consultation with each woman to produce autobiographical narratives that could be distributed to all participants (Kirkman, 1999a). One reason for distributing the narratives was to reveal the range of narrative content and styles, so that my own public narrative was not the only guide to disclosure. The women's comments on the narratives and their subsequent communications were included in the data. My approach to analysis has much in common with Riessman (1990, 1993) and McAdams (1989) in that I did not fragment text into discrete content categories for coding, but interpreted accounts as contributing to meaning in their entirety. I differ from Riessman in adopting the narrative mode of thought rather than identifying formal narratives, as she did. In this I am consistent with McAdams (1989, p. 161), who listens to accounts "with the ear of a biographer". I read the narratives many times during the course of my analysis, and tested my interpretations by giving written versions to the participants for their comment. In addition to my desire to treat the women ethically, this process guarded against merely developing interpretations to suit my assumptions. The iterative process also gave me access to new experiences and narrative revision. The analysis with which this article is concerned arose because some women began overtly to revise their narratives as the research progressed. I read all the narratives for evidence of revision and of factors that ap-
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peared to contribute to revision. (The process of revising infertility narratives is discussed elsewhere: Kirkman, 2002b.) The women's explanatory plots demonstrated how they interpreted their cultural and temporal contexts and suggested how these could impede or promote narrative revision. Barriers to revising the autobiographical narrative were identified from accounts of women who had not revised as well as from those who had done so. There is no clear and consistent distinction between women in these two categories because of the changes continually taking place. (Further methodological details are in Kirkman, 1997, 1999a.) My association with all the women was maintained between November 1994 and April 1997; a few women continue to correspond with me. All quotations in this article are taken from the women's narratives and their letters to me, with permission. Pseudonyms are used. BARRIERS TO NARRATIVE REVISION
The women were at various stages of their infertility narratives. This statement is dehberately, perhaps inescapably, ambiguous, and refers both to the lives they were living and the stories they were telling about those lives. Some women had completed their infertility narrative, with or without children; some had an unfinished narrative in progress; some were revising beyond infertility; several had tried and failed to revise. For a few women, infertility had been too recently discovered for an alternative narrative to be considered. Others may have been approaching the appropriate moment to begin revision. Barriers to narrative revision included cultural and social factors such as the dominance of the motherhood narrative, the absence of a collective narrative of the non-mother, and lack of audience support; as well as more personal factors such as a lack of meaningful alternative goals and the existence of hope. All are implicated in the narrative work of mourning. Each will now be discussed in tum. Dominance of the Motherhood Narrative
A major obstruction to the development of a new plot in the life of a woman who is involuntarily childless is the dominance of the motherhood narrative
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(Marshall, 1993; see Throsby, 2002). I refer both to the canonical narrative of motherhood and the narrative identity of individual women as mothers, which inform each other. I have discussed elsewhere the difficulty experienced by women as they endeavour to deal with the disruption caused by infertility to their identity as mothers (Kirkman, 1999b, 2002a). Most of the women to whom I spoke had, from childhood, constructed identities as mothers. They found it extremely difficult to come to a new understanding of who they were: effectively, to become different people by revising their narrative identities. This process is not assisted by the presence of a dominant canonical narrative of motherhood. (Canonical narratives are culturally-specific prototypes of plots which act as the scaffolding of our own life stories and through which they may be understood [Bruner, 1986]; they are distributed through the general stories we tell, such as those publicised in the mass media [Bruner, 1990].) There is evidence of a "new pronatalism" in Westem cultures (Morell, 2000). It has been found that non-mothers often feel stigmatised and perceive that others view them as less than whole, pitiable, and desperate; and that women who achieve motherhood in an unusual way can be seen as the "other" (Letherby, 1999). This was a powerful theme in the accounts of the women who spoke to me. Nola remarked on the novelty of "Meeting people who are bold enough to say that motherhood is not the first thing in the world! . . . Because I think that too much emphasis is put on it, by society". Xandra believed that some people assessed her as "abnormal" because she was childless. Such a belief held by a woman who does not identify as different or deviant can discourage her from revising her own motherhood narrative. Ingrid wrote of the automatic linking of marriage and children (companion to the motherhood narrative): My cousin's planning her wedding, so my brother-in-law began to plot their finances. When I asked him why - he said well, they'll be able to start having children straight away - after all, why else would they be getting married! I still cringe - what a rotten world. What if they're in love, what if they don't want kids, what if she's infertile or he is/they are. Some people just don't think.
The motherhood narrative both serves as an interpretive device for the female hormonal cycle and is reinforced by it. As Zoe said, "With the infertility, it's sort of like, every month, my period comes and you have tears, and you think, 'What's going to happen next month?"' Menstruation is a recurring reminder
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of the fertility cycle and its function in producing babies. For infertile women, it is a medical and social metaphor of a purpose that has failed (Martin, 1992). A counterpart of the dominant motherhood narrative and the sense of failure in infertile women is the discourse of the worthiness of mothers. Barbara said, "I really wanted to have children. I think being such a shy child, I wanted to be something, and being a mother was something, you know. ... I see people who've got children as worthwhile." This is part of the gendered life-course narrative in which motherhood transforms a girl into a woman: motherhood is an essential step in female maturation (see the discussion on generativity in Kotre, 1984, Chap. 1). Barbara's failure to fulfil her identity as a mother led her to tell new acquaintances on several occasions that she had children. For her, the dominance of the motherhood narrative was a powerful barrier to narrative revision. In Australia, as in similar cultures, motherhood and womanhood are strongly connected (Phoenix & Woollett, 1991; Ross, 1995). It was clear that the women to whom I spoke positioned themselves within the discourse of motherhood as fundamental to women and to society, and were frequently reluctant to revise their narratives to make them inconsistent with the dominant narrative for women. Nevertheless, in positing these dominant narratives and discourses as adverse influences in revising personal narratives disrupted by infertility, I am not suggesting that they are fixed or deterministic. They are constantly subjects of negotiation, both influencing and being influenced by society and individuals (Good, Munakata, Kobayashi, Mattingly, & Good, 1994; Mattingly, 1994). Absence of a Collective Narrative of the Non-mother
Charles Taylor (1989) argued that transitions in theories do not occur when one theory has been shown to be wrong, but when another is shown to be better. Taylor's idea of the way reasoning works in historical explanation may be applied to changes in personal narratives. It is almost impossible to change one's personal narrative until an altemative which is at least as attractive becomes available to us. However, a ramification of the dominance of the motherhood narrative is the lack of an easily available collective narrative of the non-mother. If infertile women have endured a period of trial through the medium of ART (Kirkman & Rosenthal, 1999), they may be allowed to be childless with ho-
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nour, but it may still be difficult for those women to find a collective story that gives purpose to their lives. Virginia exemplified that difficulty when she said that she could see no advantages in being without children. Research on perceptions of parents and non-parents in Australia demonstrated the existence of normative expectations of the necessity for children, preferably two or more (Callan, 1985). A question asked in the context of the contraceptive revolution is pertinent here: "how are we to be fertile if not through children?" (Kotre, 1984, p. 21). The paucity of socially-sanctioned answers to that question makes it difficult for women who are involuntarily childless to find archetypal stories on which their own narratives may be remodelled. The discourse of the selfishness of non-mothers, the obverse of the discourse of the worthiness of mothers, highlights the unfiattering public picture of childless women as selfish and hostile to children (Marshall, 1993; Throsby, 2002). Even infertile women themselves may accept that childless women are selfish. Diana said she was glad that she had adopted her son, for all his psychological difficulties, because without him, "I'd be quite fearful of becoming a selfish, inconsiderate person, because you only have yourself to think of". Enid spoke of her childless employer, who was: a very selfish person, very hard, very selfish, and looking at a very sad old age, which she did have. ... And then next door to me, I had another couple who were very similar, very selfish, and it made you think that you definitely wouldn't want tofinishlike that! Enid also described her mother as selfish. The inconsistency of these statements (infertile women are selfish; my mother is selfish) indicates the existence of a powerful discourse of the selfishness of childless women, as does the voicing of this opinion even by women who are themselves involuntarily childless. Ann, who was childless, claimed that "People who don't have children can - I don't say all, but I think probably they can become very selfish and introverted." She assessed the decision of her sister not to have children as selfish. Jenny felt the need to defend childless women against the charge of selfishness, and argued that people with children can become insular: "Everything's focused on children. If you can't have them, or you're at a stage where you're not quite ready to recognise that you can't, everywhere you tum, everywhere you look, is all about kids." Zoe wrote:
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It annoys me when people say that couples who choose not to have children are being selfish. To me this is a very narrow-minded belief. One could say that people who have a big family (more than two children) are selfish in using up so much of the resources of the earth and therefore creating a major environmental impact, leaving less natural resources for future generations. Deciding to have children should be considered as a major decision, not one to be taken lightly.
That such a defence should be necessary underlines the lack of an alternative canonical narrative to motherhood. My analysis of the dominance of the motherhood narrative and the lack of a collective narrative of the non-mother is congruent with the conclusions reached by Ulrich and Wetherall (2000). Their research on infertile women in New Zealand led them to call for a broader definition of motherhood and a wider variety of culturally sanctioned roles for women. Similarly, Marion and Rosemary both argued that schoolchildren need to be alerted to the possibilities of infertility in order to help them to prepare for a life without children. This approach could be the vanguard of the establishment of alternative narratives. As young people are learning about reproduction and safe sex, they could be taught that parenthood is not inevitable, and helped to see the value in other life stories.
Lack of Audience Support
The sense of biological and social inadequacy is reflected in infertile women's awareness that they are stigmatised (Miall, 1986). Partners in an infertile marriage often attempt to protect themselves by keeping their infertility a secret from their family and friends, depending solely on each other for support (Kirkman, 2001b; Lalos, Lalos, Jacobsson, & von Schoultz, 1985; Wooilett, 1985). Long-term narrative revision, possibly conducted in private, may be more appropriate than complying with the demands of others (including professional carers) to "let it all out" (Hunt & Meerabeau, 1993). At the same time, the joint construction of autobiographical narratives may mean that women who confront the need to revise their motherhood narrative as a result of infertility need support from the members of their family, friends, and wider social group who infiuence the development of the narrative. Some infertile women lack this support to the extent that their revision is inhibited. For example, if the pain of childlessness is assessed only by the degree of struggle to achieve motherhood, the audience (and joint author) of the narra-
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tive will implicitly encourage further feats of endurance instead of redirection. Virginia had experienced this attitude: I feel uncomfortable when I say to people that I ... can't have children, ... and they say, "Have you gone through IVF?" and I sort of feel like I get grilled. And then for some people, they think that it means that I never really wanted them, and that you have to go through all this stuff to prove that you really want them. If you are seen to be continuing to struggle to achieve motherhood, your grief may be acknowledged but you will not be supported in completing the work of mourning by revising your projected life story. If you are trying to revise that story, your grief will be disregarded and little honour will be granted to your efforts. (The role of IVF in indicating a commitment to parenthood is also noted by Throsby, 2002.) Geraldine had shared the common view that she must be happy because she has a child. This belief has made it difficult for her first to acknowledge that she has any problems to resolve, and second to "reframe" her experiences. She has not had an audience to encourage her in revising, and wept when telling me of the relief she felt when she discovered another mother who also had unresolved issues from infertility. Geraldine (along with other mothers of single children) has been made to feel that she should be grateful to have one child (as she is) and is therefore not acknowledged as someone who has still not worked through the trials she endured to achieve that one child and who mourns the other children lost from her narrative of the future. This loss lacks the support to be understood creatively. Geraldine would welcome a support group specifically to work through such issues: a group which would share the reconstruction of her life story. Similarly, Nola proposed a group of infertile people whose goal is to help each member to move on from mourning infertility. Other women valued their privacy to an extent that it deprived them of all but limited audience support (Kirkman, 2001b). Wendy, for example, chose to keep to herself her infertility and consequent grief. She gave as her reasons the need to shelter her vulnerable emotions and that it would be easier to create a child-free life when few people knew her history. In other words, Wendy believed it would be easier to revise her story in the absence of expectations from people other than her partner.
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Lack of Meaningful Alternative Goals When the goal of parenthood no longer seems to be achievable, other goals need to be put in place as the focus of a revised autobiographical narrative. Yvonne said of the experience of being infertile that, "It makes you question so much of what you want in life. I kept on thinking, if I'm not going to have children, I have to do something with my life that's important. I don't feel like that now". Yvonne had by then become a mother. It must be stressed that these are not women with no other roles in their life than motherhood. Most have careers. Nevertheless, Wendy wrote that, "I cannot at this stage envisage another goal as important as motherhood (I do not want work to be the main purpose in my life. All my colleagues would put their role as mother before that of teacher)." One barrier to revising the narrative after infertility, therefore, is the failure to find goals as important as motherhood. For some women, these goals must fulfil what Tania described as their profound "need to nurture". Barbara appeared to have important goals for her career and education, but found them to be trivial in comparison with motherhood. When asked to describe her future, she said: It'd be nice to finish my degree and keep working. ... I would be the only person in my family who's got a degree, and that would be great. ... I guess that's it; nothing very exciting. ... People have goals and aims that they drive towards, and I think I'd like to have those sort of things. I sit down and try and work them out every now and then, but haven't been able to come up with anything really great. ... [My life is] the same as the goals, you know; it just drifts along. ... Sometimes you think, where do I fit in? What am I here for? You know, I'm going to live and then die, and there's nothing to continue on.
One reason for the inability to find satisfactory goals is likely to be the grief occasioned by infertility, the sources of which have been summarised in terms of three negations: thwarted love, exclusion from the family structure, and genetic death (Houghton & Houghton, 1984). The term coined by Olshansky (1962) for parents of disabled children has been applied to the infertile (Burke, Hainsworth, Eakes, & Lindgren, 1992): chronic sorrow. An insightful essay on the grief of widows could equally apply to a woman's loss of the relationship with her hoped-for children and her self-asmother: Grief is a reaction to the disintegration of the whole structure of meaning dependent on this relationship rather than to the absence of the person lost. Correspondingly,
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people work through grief by retrieving, consolidating, and transforming the meaning of their relationship to the person they have lost, not by abandoning it. (Marris, 1982, p. 195)
Infertile women need to rework the meaning of their lost children and their self-as-mother within the narrative interpretation of their lives. The resolution of grief is idiosyncratic; but "however it is achieved, the recovery from a severe loss seems to depend on restoring the continuity of meaning" (Marris, 1982, p. 196). The need for continuity in grief-work may not only exacerbate the difficulty of finding new goals, but may mean that it is inadvisable to try to put them in place before grief has been resolved. Virginia recognised the need for such grief-work when she declined to use reproductive technology because "it would delay my grief". Other complex emotions which can accompany the grief of infertility also obstruct the search for new goals. Wendy had sought counselling in an attempt to come to terms with infertility, but her anger at the unfairness of her situation was a hindrance. An essay by a woman whose only child was killed nearly eight years before, in the aeroplane blown up over Lockerbie in Scotland, suggests parallels with Wendy's grief and anger. Susan Cohen (1996) found that grief counsellors were worried by her anger, but said: Of all the emotions I have felt since Theo's murder, anger is the best. Rage gives me energy. Rage makes me strong. ... The passage of time has helped. I get up every day, go places, meet people. I live my diminished life. But grief is always there. Because her daughter wanted to be an actor, Cohen cannot now enjoy the theatre as she once did. She must be eternally vigilant against depression. I see parallels here for some women who are involuntarily childless. Their mourning is incomplete. They resist being told how to revise. They avoid occasions where they will have to confront children. Their lives are diminished, and other goals cannot compete. Sometimes depression will sneak past even the vigilant. Depression will dull interest in familiar pleasures and eradicate any drive to the establishment of new goals. Rosemary described the aftermath of her miscarriage and the realisation that she would probably never have a child: I was very depressed. The blackness was awful\ ... it was frightening. You feel like you're never going to get out of this black hole, and you get to a point where you understand why people commit suicide: ... it's one way to stop the pain.
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Rosemary set herself the goal of completing a university degree, but was haunted by her fear of doing badly, thereby compounding her sense of failure. She envisaged her next challenge: I'm bracing myself for my friends to start announcing that they're grand-parents; ... but at least I'm expecting that. ... I think we have to find some other goals. ... I keep thinking in terms of recovery, because I think it's an on-going process. ... I have a few goals; one is that I'll feel like I've recovered when I can lose a lot of the weight I've gained; ... because I'm not really feeling all that well with it. But it seemed like too much effort to be bothered for a while.
Rosemary - and other women who recognised the need for new goals - had difficulty not only in working through the process of mourning to a point where they could begin to establish goals, but also in establishing goals that were achievable and did not represent threats or punishment. Hope
The therapeutic value of hope has been acknowledged (e.g. Nekolaichuk, Jevne, & Maguire, 1999). In writing of his own experience of disabling illness. Murphy (1987), emphasised the necessity for an interpretation of events which allows for hope, particularly when the narrative of the future has been erased. Crites (1986) wrote, in the same vein, that to avoid despair it is essential to allow for possibilities in the future. However, the existence of hope may also be identified as an obstacle to revising the plot of one's life. It has been said that the inherent ambiguity of infertility maintains hope (Sandelowski, 1987). Some critics blame ART for maintaining hope and preventing the resolution of grief (see Becker, 2000). For example, it has been claimed that those who believe infertility to be permanent may be able to come to terms with it and therefore demonstrate fewer symptoms of distress (Koropatnick, Daniluk, & Pattinson, 1993). When Wendy read what I had written about the role of IVF in maintaining hope (in a paper distributed to the participants), she wrote: I quite agree with that. Since I embarked on IVF, I have maintained that the six Medicare funded attempts and age 40, which have conveniently coincided, would be the end. I am now fairly certain that I will continue, using the two frozen embryos I have stored and may even consider paying for a further stimulated cycle. I think I am considering this not so much because I think it will work, but more because I am afraid to stop and face the end, and get on with life. If I do not have IVF in my life, what do I have?
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However, it is not only technology that encourages infertile women to hope. Diana was "very fearful" of fertility treatments and refused to use them, yet hoped that she would become pregnant naturally. As she reached menopause, she "went through a really bad time". It had been reassuring to her to live in a world of possibilities. This maintenance of altemative narratives has been called "subjunctivising" (Bruner, 1987; Good, 1994). In grammar, the subjunctive mood is used to express a wish, or a contingent or hypothetical event. When extended to narrative, it encompasses the multiple prospective plots which are possible when one is still living one's story. (If A happens, I can do B; should C occur, then I will take D direction.) Byron Good (1994) pointed out that the quest structure of narrative presupposes subjunctivity. He identified subjunctivising particularly in chronically ill people who retain hope; they can see possibilities for the future. Those who are hopeless or resigned to their illness have only a single prospective narrative. Hope, hopelessness, and subjunctivity are seen in the narratives told by infertile women (Kirkman 1999a, 2002b). Other women who subjunctivised included Fiona, who thought she still had a chance of motherhood until a hysterectomy was performed; and Ingrid, who had already developed for herself a narrative of the future that revolved around being child-free, but was undone by a threatened hysterectomy. She wrote: I have had chronic pain for years - and it can only be a relief. Yet I cried and cried. Bitterly. Sure, I said great we're child-free - life can be fun. But now there's no chance at all, of having children. ... All the old feelings well up again - and the resentments.
The finality of a hysterectomy exposed a lingering altemative plot in which a surprise pregnancy is possible. Hope may forestall coming to terms with the need for a revised life story and identity, but hope may be essential in dealing with the blow of infertility. Pamela said that she was "not desperate. . . . Probably because there's hope there, though; that's probably the reason". Hope may carry some women through the mouming period of confusion and readjustment; sudden hopelessness may be too much to bear. Louise, for example, had been able to view the prospect of a childless life with relative equanimity before her hysterectomy because she nurtured the hope of advances in medical science that would overcome her spinal problem. Once she had the hysterectomy, all hope
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was gone; she sank into depression and attempted suicide. Hope may therefore guard against nihilism; it can provide protection, a fall-back position, while harsher events are accommodated. Louise could be brave about childlessness with the safety net of faint hope for a child. Hope may also help in revising, because it allows the creation of a new life narrative whilst leaving open the option of the preferred narrative. As with so many other aspects of the complex experience of infertility, there can be no simple rule for what will help and what will hinder a person's ability to cope with its vicissitudes.
CONCLUSION
The narrative work of mouming makes heavy demands of infertile women: they must deal with the major upheaval of revising their autobiographical narratives, including reconceptualizing the future, redesigning the present to suit those new goals, and reinterpreting the past to make it coherent with these revisions (Kirkman, 2002b). This article has described barriers to the construction of a revised narrative, including the dominance of the motherhood narrative, the absence of a collective narrative of the non-mother, lack of audience support, lack of meaningful altemative goals, and the existence of hope. The complexity of the work of revision and the need for caution in encouraging premature revision is exemplified by the paradoxical role of hope in dealing with the blow of infertility. It is presumptuous to suggest that infertile women who are involuntarily childless must revise their autobiographical narratives. Some women may not revise from a desire to protect their identity, to sustain the familiar story of who they are. Or they may prefer to maintain their rage. In many other circumstances, when a major obstacle is placed in the way of achieving a goal, perseverance is encouraged. It is commended in people like athletes and scholars, business people and mountain climbers, but condemned as irrational and inappropriate in infertile women who want to fulfil their narratives of motherhood (Koch, 1990). Some women who have not revised their autobiographical narratives in the face of infertility may not yet have arrived at the right time to do so. Revising may be in the future. Pamela was hinting at that possibility when she said: "If we couldn't have children, I would never want to become bitter like some people, because I think being bitter is so destructive".
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It must be stressed that the barriers that I have identified are not insurmountable. Barbara, who used to feel unable to escape her narrative of motherhood, recently wrote that "I have had a great year this year"; and Louise, who once attempted suicide as a decisive solution to infertility, wrote that, "We have finally accepted that we will have no children of our own, so we have started fostering. It is actually very rewarding". I will conclude by quoting Marion and Olwyn to illustrate both the continuing narrative influence of infertility and the striving for narrative revision. Marion, still childless after years of occasional ART, wrote to me in the year after the research had finished to say that she had "had to accept the sadness that accompanies this unexpected climax to my story". She added: I have probably moved on a little since I spoke with you. I am beginning to accept the fickleness of nature and the random cards it (surely not she!) deals. I am trying to decide what a quality of life without children means to me and embrace the freedom which this offers.
Olwyn, who had two young children, wrote: As I said in the 1st interview it is an experience that has changed my life - infertility, as well as having children. I don't mean I dwell on numbers of injections, drugs, feeling of hope and despair that infertility & ART brought, but I feel the experience has helped shape the sort of person I am, how I view life and perhaps what I do in life. It was a crisis in my life that demanded direction change, strength, and brought about personal growth. I believe we view the experience in perspective, in a balanced way, but it is not something we forget.
ACKNOWLEDGEMENTS
This article reports part of the research conducted for my PhD thesis at the Australian Research Centre in Sex, Health and Society, La Trobe University, Victoria, Australia. It was supervised by Professor Doreen Rosenthal and supported by an Australian Postgraduate Research Award. A brief version of this article was presented at the conference Life Stories and Personal Narratives, July 2000, Monash University, Australia. I thank William Leonard for helpful comments during the development of the article.
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