Why TFMR* Can Feel Like An Existential Crisis

*TFMR = termination of pregnancy for medical reasons, a specific case of abortion when the gestational parent is faced with the decision to end a wanted pregnancy due to a prenatal diagnosis or their own medical condition

When I think about the shock of learning that one’s baby has a poor prenatal diagnosis, grief, anger, and sadness come to mind as immediate reactions.  More recently, I have framed the experience as a trauma which explains why the aftermath can feel akin to an existential crisis. 

 

If you have recently been through a TFMR and you feel lost, confused, detached, or numb, you are not alone.  If your previously-held identities felt unshakeable and now you are contemplating anything from a cross-country move to a drastic haircut, you are not alone.  (Affairs and sportscars are still possibilities but not the ones I see most commonly.) 

 

As a psychodynamic and relational therapist who uses an existential lens, I cannot help but look at life as an existential mindfuck—Sartre declared that we are “condemned to be free.”  Even in terrible situations, like TFMR, there is choice, but instead of feeling freedom, many experience it as a heavy burden. I often hear from clients “It’s not fair.”  It is definitely not fair and part of healing involves grappling with this harsh truth that some people encounter for the first time with TFMR.  For some, being faced with a decision between a bad outcome and a worse one can lead one to ask some really big questions about the universe.

TMFR really highlighted for me the existential dilemmas embedded in life as a human who can contemplate mortality, relationships, and whether life has any meaning. 

 

After my TFMR in 2007, my life, career, and personal relationships shifted significantly but not immediately.  Although I did go on to give birth to healthy babies for whom I am very grateful, I also gave birth to a new version of myself.  I no longer had patience for negative people (and I also didn’t have patience for toxic positivity.) In other words, I could tolerate 3 people and one of them was my dog.  I didn’t want to have superficial conversations with acquaintances.  I wanted to my work to feel more meaningful and no longer wanted to sit in DC-area rush hour traffic.  And some changes were more subtle—my introvert tendencies revealed themselves during that time.  I am still me but “me” feels more complicated than it did before.  Going through a TFMR wasn’t the first time I contemplated my own mortality but suddenly life felt way too short and there was so much I wanted to do. 

 

From years of hosting support groups with other TFMR parents, I know that my experience is a common one.   Priorities shift, sometimes seismically.   Worldviews can change dramatically. The good news is that it gets better—I regained patience for others and embraced the “new me” which allowed me to get outside my comfort zone in some really great ways.

 

Bearing the burden and responsibility of making a decision about whether or not to continue a pregnancy can very much feel like an existential dilemma.  I have never met a pregnant person who wanted to be in that position—it’s a choice people would rather not make.   It’s often a choice between different, but terrible outcomes which somehow doesn’t feel like a real choice.  For “grey” diagnoses, where the fetal anomaly is not fatal or when there is a range of possible outcomes, the decision can be especially difficult and painful.

 

For many, TFMR can rise to the level of trauma—which often results in an existential crisis—losing the illusions of safety and control once held can be devastating and disorienting.

 

There is no one solution to helping others heal from TFMR but an existentialist approach would look to the creation of meaning as a way to manage the grief about the baby who died as well as the shattered illusions of a “just world.” It is not always easy to create meaning out of a situation that is often seen as “senseless” or devoid of any particular meaning, especially when the medical feedback is that the fetal anomaly was a random genetic event.  However, when people can face the reality of their situation head-on and make a decision in the worst of circumstances then they are more likely to heal and move forward in a way that feels meaningful.  My patients may never feel “good” about their decision but my hope is that they will feel stronger for having been able to face their choices and move in a clear direction.  The need to decide forces a revisiting of prior beliefs about abortion and about values, more generally.  These beliefs form the building blocks for their rationale in choosing a path. 

 

Creating meaning or a sense of purpose is one way to manage the terror of finitude and to cope with the inevitable suffering that is part of life.  The task is not “getting over” the loss but finding a way through it such that it becomes integrated into one’s personal and family narrative.  In this way, creating a narrative of what the TFMR decision means in the lives of individuals is a major task of therapy from an existential perspective.   Solidifying one’s identity as a parent (or as a non-parent) is another existential task in healing from TFMR.  Finally, working through concepts of fairness and unfairness, shedding illusions of control and invincibility, and creating a sense of resilience and strength after facing something very difficult can all be part of the work to be undertaken in therapy.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Rachel Freedman
Introducing a new discussion group for women who are “sober-curious…”

More and more, women are initiating conversations with me about their alcohol use.  They are expressing concerns about their drinking even when they consider themselves to be “moderate” drinkers.  They want to stop or cut back but they aren’t sure where to start. 

There is research that alcohol poses unique risks for women.  Annie Grace, in her book, “This Naked Mind,” a guide to quitting drinking, cited some sobering (pun intended) statistics on the link between drinking and cancer for middle-aged women.  Alcohol is also marketed to women in different ways than it is marketed to men. Women, especially mothers, are encouraged by marketers and advertisers to use alcohol as a way to relieve stress and engage in self-care. 

Because of the complicated relationship so many women have with alcohol I am offering a short-term discussion and support group for women who want a safe and confidential space to explore their drinking.   The ideal group members are women and female-identified people who feel like alcohol is no longer serving them but aren’t sure they want to stop drinking. We will use the book, “This Naked Mind” by Annie Grace as a starting point.  We will focus on the intrapsychic and relational aspects of alcohol use as well as the fears and hopes of group members, regardless of whether the goal is reducing alcohol intake or sobriety.  

If you are brand new to the sober literature and looking to learn about the experiences of others who chose sobriety, you might read one of several memoirs that are available in this genre.  I have read many of them!  They are not all amazing but the cumulative effect of reading several sober memoirs made a significant impact on how I understood the dilemma of alcohol addiction. Often, individual stories have common threads.  The typical plot lines:  smart, successful, feminist woman drinks too much in an attempt to manage stress, cope with trauma, prove her worth, or cope with pressures of the patriarchy.  In the sea of sober memoirs, the one I recommend is “Blackout” by Sarah Hepola.

Finally, if you are a runner or triathlete (or anyone) who is struggling with drinking, I highly recommend Meredith Atwood’s website and blog.  She is a woman with a story to tell and she tells it with eloquence, grace, and courage.  Find her at https://swimbikemom.com

For more information about my book discussion and support group, go to the Groups tab on my website. 

 

 

 

Rachel Freedman