How to Look on the Bright Side (Part 3)

This is the part where I try to sum up a lot of thoughts about the "encouragement card" given to a woman by her clinic (Part 1) and the study that led to the card's creation (Part 2). Let's start with the obvious, alright?

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The encouragement card (PRCI) did not work for me.

Apparently, I'm in the minority of women who—given only the two choices that were offered in the study—prefer the PMI affirmations over the PRCI card.

It's not that affirmations like "It's great to be alive" feel especially true right now. Actually, that's kind of the point. I see them not so much as true or untrue, but simply as ideals, maybe even fantasies where I can briefly escape. Living with them for a moment is all that's required. Because it's so easy to do, the affirmations somehow bypass the tangled hairball of thoughts in my head and just make it easier to breathe for a minute or two.

In contrast, the PRCI statements get my guard up right away. They tell me to do something that I don't know how to do, and they make it sound easy.

It's not easy. What ARE the "positive aspects of the IVF experience" or infertility in general? It hasn't brought me the closer relationships mentioned as an example (in Part 2). It has led to some wonderful new relationships, while putting others under strain.

I am aware that just being able to try "the most advanced fertility treatment" makes me compare "favourably with others who are less well off," and I'm grateful for that chance, but I'm also aware that it's only a very small CHANCE to do what most people do naturally. A chance is NOT (repeat, NOT) any kind of guarantee. And when it doesn't work, then what?

What have I gained? About 15 lbs. Also, several containers full of used needles. Possibly, on the best days, a slightly better sense of humor and awareness that everyone is fighting some kind of battle, whether it's visible or not. What have I lost? Most of my life's savings, half a decade of my time, and all of this.

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The intention was so good that I hate to criticize the execution.

The introduction to the study (Part 2) does a good, detailed job of explaining exactly what's stressful about IVF. Because infertility can create so much stress and pain, I'm truly glad to see attention being focused on mental health in this context. These people recognized a need and made quite a serious effort to address it. That's great!

Also, just because the PRCI doesn't work for me doesn't mean it doesn't work. Other patients apparently do feel helped by it to some degree. Honestly, those results rattled me, making me question whether bitterness may be obscuring my judgment. After more thought, though, the way I see it now is just that different people prefer different tools, and the two covered in this study are by no means the only ones that exist.

Even if I can't think up "positive aspects" of IVF—the main way these researchers envisioned women using the PRCI card—it did help in one way. It prompted me to make my own encouragement card (in Part 1), remembering other methods I've used to look on the bright side more authentically.

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But let’s be honest: there are problems with the execution.

I see two problems with the PRCI card and, to a lesser degree, with the PMI affirmations. The PRCI's vagueness and repetition (all the variations on "be positive") are the most obvious issue. Underneath is the unquestioned assumption that being positive should be an IF patient's main mental-health goal.

Isn't it important to maintain a healthy attitude? Well, of course. It's one of my main goals every day, and I'll always be willing to try any strategies that are aimed at genuine healing. ALL of them. The more the better! The thing is, I don't always equate "healthy" with "positive."

In Part 1, two commenters wrote about the need to acknowledge all of our emotions, dark and light, as the only way to get through them (not over or around them), and I agree. Forced positivity can invalidate people's real experiences. Positivity becomes forced, I think, when these impulses are at work in the person who's giving the advice:

• Enforcing a smiling decorum
  This mode prioritizes seeming good over feeling good. Some people are just uncomfortable with grief. They want us to feel better. They may think that by acting like everything's OK, we may come to believe it, or at least we'll avoid bothering anyone else. But it comes to feel draining and fake. Suppressed feelings tend to leak out anyhow, sometimes in more damaging ways.
• Lecturing with "at least" statements
  Saying that we can't be sad because someone else has it worse is like saying that we can't be happy because someone else has it better. Actually, it's possible to feel happy AND sad (or other emotions) all at the same time. Appreciating the good doesn't require denying the rest. Denial just makes a habit of disassociating from reality, which can also interfere with feeling good.
• Blaming circumstances on attitude
  Of course, the choices we make contribute to some of the outcomes we have. On the other hand, sometimes shit just happens. But if people can think up a "reason," they can feel smugly assured that similar things won't happen to them if only they don't make the same "mistakes."

I doubt that the people who developed the PRCI were motivated by the impulses above. They were, I'm sure, sincerely trying to help, and the tool they created was based in part on feedback from the study participants.

But I still worry that the shallowness of the statements in the PRCI promotes putting on a happy face (decorum) more than true healing.

One of the stated intentions was to help people focus on "comparing oneself more favourably with others" ("at least" statements), especially other IF patients. While it isn't inherently wrong, I guess, it hardly seems complete. What I hear is, Hey, we know the situation sucks enough that you need encouragement, but let's pretend it's not true by focusing EXCLUSIVELY on the 5% that's OK. That feels delusional.

Finally, acting as if a simple attitude adjustment is all that's needed may leave people blaming themselves (blaming circumstances on attitude) if they end up still struggling.

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Can I frame all this in a more "positive" way?

My goal is to feel not so much positive as whole, which means somehow integrating the most unpleasant truths in my life without getting overwhelmed by them (lost in self-pity, depression, and so on).

How to do that? Well, I'll start by acknowledging that it's not easy! It's probably the work of a lifetime, in fact. Seeking that balance has been the driving force behind this blog for over 100 posts now, and it feels like I've made just the barest beginning. I'm nowhere near done.

And my personal "encouragement card" (Part 1) is not intended to be the final word. It's the result of one evening's worth of brainstorming. It's an attempt to start a conversation.

So again ... what would you add? What strategies have kept you relatively healthy and whole when dealing with the hardest parts of infertility? Also (and this is much harder than it sounds), can you summarize them in a few words that would fit in a pocket-size list?

What would be on your personal encouragement card?

The Sadim Touch

Someone just pointed out this Slate article about a new website called Modern Loss. The article says:

"Americans love to talk about people who overcome the odds to survive serious injury or illness, but we don't cope with death very well. Enter Modern Loss, a new website dedicated to helping us stop treating death and grief like embarrassments to be hidden away, and instead have an honest conversation about what it means to mourn. 

The site was started by two women, Rebecca Soffer and Gabrielle Birkner, who lost parents at an early age and who are clearly opposed to the toxic forced optimism [emphasis mine, because I LOVE this phrase] of American culture that can make grief all the more difficult. They promise a website that will be free of people adjudicating how sad you're allowed to feel and a complete ban on the phrase, 'everything happens for a reason.'" 

Did you hear me cheering at that last line? Please, oh please, can we get rid of that platitude?

There, now it's fixed!

So I had to check out Modern Loss, and right away I found a lot to like, especially one post: The Reverse Midas Touch.

While my recent string of losses hasn't been as drastic as what author Abby Sher describes, it has made me wonder if I'm—if not cursed—maybe attracting bad stuff into my life in some subconscious way. Short answer: NO, I don't believe in hocus-pocus. But still, honestly, there are times when I have kind of felt like a freak. There are times when I've been ashamed of my own apparent Sadim (the reverse of Midas) Touch.

Right after my miscarriage, I happened to see this video about stillbirth. The parts that resonated most were the parents who talked about feeling like a bad-luck charm, and those who said that the worst thing was when people refused to talk about their child at all. That is "toxic forced optimism" at work.

I do understand the impulse; I've been guilty of it, too. But I've come to see another way: simple, loving presence. Abby Sher offers it to a sick friend at the end of her post. Others have offered it to me.

One particular time stands out: after the baby’s heartbeat stopped and before the bleeding started, a friend put his hand on my belly and just held it there, silently, head bowed. That simple act of acknowledging that he/she was real and still mattered, even after death ... of coming closer instead of running away ... it was one of the most healing things anyone has ever done for me.

Stick It

A while back, a single friend and I had a funny (and healing) talk about the stick-figure family trend. We both felt rubbed the wrong way by the stickers, then a little embarrassed by our own apparent envy, but then still annoyed. They present such a small and conformist slice of life. Can we get more creative here?

How about stickers of a woman surrounded by doctors and syringes (a picture of our own infertility treatments at the time)? It could work for other medical problems, too! What about the unhappy couple, backs to each other, both on their phones to someone else? Or the happy but long-distance couple, stuck on opposite sides of the car?

Don't get me wrong; I truly don't wish troubles on anyone or expect anyone to wear them with pride. But we all have some. The people I respect and envy most tend to be the ones who acknowledge it and keep moving forward all the same.

Dignity

"As you face loss, hurt, and conflict, invite a sense of your own dignity. Sit up, stand up tall. Have respect for yourself, and patience and compassion." (Jack Kornfield, A Lamp in the Darkness)

I like this quote, so I've been thinking about what it means to have dignity … and I'm honestly not sure. At what point does "invite a sense of your own dignity" become "pretend that you are fine when you are not"?

I'm pretty sure that dignity does not just equal decorum, which means conforming to all the rules of polite society. Dignity has more to do with honoring a person's worth, which is something inherent, I guess. But what does that mean in real life? After two pain pills and a sleepless night, these distinctions seem pretty obscure. They still seem important, though. I need some kind of guidelines to follow.

Staying in pajamas all day does not conform to the rules of decorum, but when is it actually undignified or unhealthy? Does it matter whether I've consciously chosen to be gentle with myself, or whether I've just given up? And wouldn't scolding myself for feeling defeated be undignified in its own right, if dignity requires patience and compassion like the quote above contends?

See? It's confusing. When I get caught up in these questions, my mind eventually drifts back to the days right after getting the bad news. I found myself responding to everything with an attitude of "So what, who cares?" I'd look at my unmade bed and think, "It doesn't matter." I’d look at work piling up and think, "I don’t care."

Then it felt very important to stop, even physically put a hand over my heart, and acknowledge, "I DO CARE."

No, these things can never mean as much as my baby's life. I may act on them (the work) or not (the bed). In any case, I cared enough to notice them.

The point is that the part of me that cares (to whatever small degree) about other things is still alive, and it wants (to whatever small degree) to stay that way. Maybe that is dignity.