At the tail end of the 1990s, researchers in Pittsburgh coined a new  term for grief that was unresponsive to treatments that had had proven  results on symptoms of depression: Complicated Grief Syndrome. By the  turn of the new millennium, thanks to funding from the National  Institute for Mental Health, Complicated Grief research had become a  rapidly growing field. In 2009, Dr M. Katherine Shear, a professor of  psychiatry at Columbia University, estimated that almost 15% of the  ‘bereaved population’ were affected. A significant majority of those who  have been diagnosed with Complicated Grief Syndrome are parents who  have lost a child.

Grief is an extreme emotional state, caught between the literal  extremity of death — the furthest possible end, or terminus, of a life —  and the radical alteration loss enacts upon the lives of those left  behind. The Oxford English Dictionary gives a definition of  ‘extreme’ as ‘the utmost imaginable or tolerable degree of anything; a  very high degree’. The death of a child seems to exceed this extremity:  its contravention of what we perceive to be the ‘natural’ order of  things — the child expects to bury their parent, and not the other way  round — is repeatedly described as ‘unimaginable’. Complicated Grief is  often referred to as an ‘extreme’ form of a natural state. The  distinction between ‘complicated’ and ‘normal’ grief builds on Freud’s  definitions of mourning and melancholia: the former prevents the  bereaved party from continuing to live their life. This kind of  experience, Dr Shear believes, ‘has no redemptive value’.1 Unsurprisingly,  this explicit medicalization of grief is controversial, particularly in  its reliance upon the language of ‘normality’, disorder, and treatment.  Yet Shear’s treatments draw on more traditional psychoanalytic methods:  talking cures. In an article published in The Atlantic in  November 2016 entitled ‘Is Grief a Disease?’, Andrea Volpe, after  observing several training sessions at Columbia University’s ‘Center for  Complicated Grief’, declares — with reference to Aristotle — that  ‘grief is a problem of narrative’.2

Elegy, a term that means in its strictest sense a verse lament for  the dead, is in practice applied to the wide variety of writing that  enacts the work of mourning. If grief is a problem of narrative and  nothing more, then elegy is rendered a purely productive tool; a  mediating force to curb emotional excess. This notion of ‘redemption’ as  the locus of grief’s ‘value’ is recognisable from early religious  elegiac writing: loss in the context of faith contained within it the  possibility of resurrection, cleansing and reunion. In his landmark 1994  study Poetry of Mourning, Jahan Ramazani illustrates the  crucial role played by consolation in traditional elegy, before  diagnosing modern elegy’s tendency to reject consolation: from the late  Victorian period onwards, he contends, elegiac writing moves towards the  anti-elegiac. This is rooted in a profound suspicion of ‘the  psychological propensity of the genre to translate grief into  consolation’ — again, a form of Freud’s normal mourning — and serves to  emphasise elegy’s position as a locus for an explicit ethical and  psychological unease:3

Modern elegists are wracked by what I call the economic  problem of mourning — the guilty thought that they reap aesthetic profit  from loss, that death is the fuel of poetic mourning. They scrutinize  the economic substructure of their work, often worrying that their poems  depend on death and hence collude with it.4

For Ramazani, the combined effects of secularization and rapid  medical advances serve to defamiliarize death and lead to the increased  anxieties of the modern elegy. For those suffering from Complicated  Grief, then, the likelihood of writing leading to redemption feels  remote. In fact, Ramazani observes that texts of parental bereavement  have proven more difficult than others to situate in the consolatory  tradition; even in historical contexts in which religious faith encodes  death with the promise of the afterlife, elegies for children find  compensation harder to accept. The idea of ‘narrative’ recuperation is  further complicated by the peculiar temporal position occupied by elegy.  R. Clifton Spargo writes of mourning’s ‘psychological trick of time’:  elegy feels simultaneously retrospective and preventative, a way of  ‘warning without agency’.5

Denise Riley, in her 2012 essay Time Lived, Without Its Flow  documents her response to the death of her son, Jacob, in 2008. The  title refers to the feeling of ‘a-temporality’ that comes in the wake of  such a bereavement.6 Riley  rejects the temptation to pathologize, and instead emphasises that this  is ‘a state that’s not rare, but for many is lived daily’: it is not  that your sense of time is ‘distorted’ but that you are no longer ‘in’  time at all. Riley notes that, ‘if time had once ushered you into  language, now you discover that narrative language had sustained you in  time’. ‘Narrative’ here gestures to the ‘normal’ chronology of  parenthood, and the assumption that the work of mourning will fall to  the child. This chronology is encoded in language itself: there is, as  Riley notes, no specific term — the equivalent of ‘orphan’ or ‘widow’ —  for a bereaved parent. Rather than requiring a narrative solution, then,  ‘complicated’ grief undermines our very notion of narrative itself.  This is not to suggest that the elegies themselves are not important:  throughout her relentless interrogation of the purpose of these texts,  Riley refuses to underplay necessity. ‘Wherever is this literature — for  it must exist, it’s needed?’

Poetic representations of parenthood converge at the intersection of  biographical fact and subjectivity, at the problem of ‘truth’ and its  potential for appropriation. Economic unease is linked to what Denise  Riley terms the ‘linguistic unease’7  of lyric poetry, emphasising its ethical and sociopolitical elements,  as well as the difficulty of subjective expression when feeling and  language are perceived to be one and the same.8 If  morality and subjectivity are linked, a lyric anxiety about responsible  speech is only heightened by the silence of the subject in these  parental texts: infancy, as well as death, is a condition that prevents  self-representation. The ethical unease of elegy and the linguistic  unease of poetry, then, are fruit of the same tree. ‘Unease’, literally  the want or lack of ease, exists only by negation; is born only into  death. ‘Ease’ relates to work: it can mean, according to the OED, both ‘freedom from the burden of toil’ and ‘comfort, convenience; formerly  also, advantage, profit’. The relationship between ease and death  hinges upon this distinction. In John Keats’ famous ‘Ode to a  Nightingale’, the poem’s speaker relates death to ease: ‘for many a time  / I have been half in love with easeful Death’. This feels like a  desire to be released from burdensome existence: the burden of surviving  comes in the aftermath of the death of the loved other. In their  concerns about the possible exploitation of the silent subject — dead or  living — these texts attempt to understand the relationship between  poetic work and the work of parenthood: the productive purpose of  writing bereavement.

Modern, anti-consolatory elegiac writing, then, can become a kind of  chiastic loop, oscillating between the desire to move on into narrative  and a resistance to this reclamation of purpose, of gain from loss. What  happens, then, when the death as well as the grief might be termed  ‘complicated’? In the decades since Complicated Grief Syndrome was named  and Poetry of Mourning was published, advances in medical  technology have been rapidly altering not only our perception of death —  more than half of all babies born in industrialized nations since the  year 2000 can expect to live past the age of 100 — but of reproduction,  too. There are endings that cannot be traced to a definite beginning:  the loss of a stillborn child, and the loss of a potential child or  children through the failure of IVF. As the boundaries of ‘normal’ life  shift and change, we can use this anti-consolatory tradition of elegiac  writing to illuminate the need for a continued conversation about the  intersection of literature and life, science and ethics. The  relationship between productivity, parenthood and mourning reinforces,  rather than alleviates, the ‘complicated’ problem of grief and  narrative.

*

There is an ongoing theological and scientific controversy over when  life can be said to begin, something inherently linked to the long  history of religious and medical control of, and legislation over,  women’s bodies. Perhaps because of this, there are differing legal  definitions of stillbirth across the world, many of which still place  implicit — or overt — blame on the mother. Although broadly defined as a  foetal death that comes at least halfway through a pregnancy, in most  European countries the definition depends on the child’s weight —  usually of 500g or more — whilst in the United States there is no  standard definition. Despite a growing movement in several states to  change legislation, in the American healthcare system grieving parents  are unable to claim a tax exemption on their medical expenses for  stillborn children. To ‘claim’ for this death, you need a social  security number for the deceased, something that can be offered only if  it can be certified that the child came out of the womb alive. It is  easy — and perhaps ethically necessary — to shudder at the explicit  economics of loss that such a healthcare system insists upon: it is at  the very least inhumane and at worst inhuman. A consideration of the  relationship between life and cost can, however, subvert some aspects of  elegiac unease.

Ramazani convincingly shows that elegy cannot inhabit an ‘aneconomic’  space, depending upon death even as it rails against it. Yet the  anomalous space occupied by a stillborn child is by definition situated  outside of the human life cycle. In writing about stillbirth, the loss  of the child cannot be straightforwardly transformed into a gain because  the child has never existed as an independent being within the natural  rhythms and processes of human life. Elizabeth Jennings articulates the  potentially aneconomic position of the stillbirth in her 1967 poem  ‘Child Born Dead’:

What ceremony can we fit

You into now? If you had come

Out of a warm and noisy room

To this, there’d be an opposite

For us to know you by.

The poem goes on: ‘You could not come and yet you go.’ The child is  unknowable but nevertheless is mourned: a loss is experienced, despite  the curtailed possibility of gain. The final two lines of Jennings’ poem  imply that this negation of potential benefit annuls any possibility of  solace outside of the work of grief itself — ‘then all our consolation  is / That grief can be as pure as this’ — yet this assertion of ‘purity’  is immediately discoloured by the fact that the reader is presented  with the emotion at one remove; almost in translation.

Peter Riley, in his 2008 poem Birth Prospectus. The End of Us.,  also presents stillbirth as something outside our normative  construction of time, something impossible to categorise or rationalise:  ‘The child dies into what we call birth. / We call it birth and furrow  on’.9  Still, the language of productivity is ever-present: in relation to the  pronouns that locate them, ‘furrow’ and ‘earth’ inhabit the same  semantic field as Ramazani’s concern that elegists ‘reap aesthetic  profit from loss’. Birth Prospectus employs the vocabulary of  profit ambivalently. It is apparent that a fiction of productive  equilibrium is not enough to transform the stasis engendered by the  ‘still point’ of stillbirth into productivity. Instead, it is a very  present lack: ‘the nothing that accounts for all’.

The title, too, refuses consolation, as the productive optimism of  ‘birth prospectus’ is stifled both by the full stops that seal off its  movements and by the doubled but deadened ‘us’ that ends each half. This  buried repetition of the hopeful collective noun suggested by  ‘prospectus’ — the prospects of us — appears to contain its own  annulment. ‘End’ can mean both ‘limit’ or ‘termination of existence’ and  an ‘event, issue, result’, a ‘final cause’: the end of the child  results in the metaphorical end of the parents, but also in the textual  issue, a poetic gain. In his essay about the sequence, Riley reiterates  this link between outcome and terminus:

In 1975 my wife was delivered of a dead baby girl in  Stepping Hill Hospital, which is what the whole thing is about. That is  what is announced in poem 1. Poems 1-7 reiterate the event, and the  still-born child is the ‘you’ addressed intermittently throughout, the  little spinner, the figure of the still point of unlimited potential,  the nothing that accounts for all. Everything that is perceived in the  poem: land, stars, creatures, everything, is perceived through this  death, which guides perception through the world.10

This ‘guide’ through the world is present in the sequence’s pastoral  imagery, historically common in consolatory forms of elegy. The natural  world hints at a kind of restitution in ‘unlimited potential’ as ‘the  mourner is thus freed from his work of mourning rather than stuck in  perpetual grief, and can re-enter nature’s rhythms of renewal’.11 The poem continues, complicating this:

Because of this (which is natural)

a surplus of energy builds into the

grass and the trees of the forest

elegantly describe themselves as

interim customers, under contract

to the oceanic combine. It all stays.

The move here into the vocabulary of economy and production — as opposed to reproduction  — jars, despite the veiling elegance of Riley’s sibilant ‘forests’ and  ‘grass’. The child is transformed into ‘surplus’ energy, and even the  landscape succumbs to ‘contract’, to ‘custom’, and the dangerous double  edge of ‘combine’: whether it refers to a harvesting mechanism or the  furtherance of commercial interests, the stability of balance implied by  the subsequent ‘it all stays’ does not feel compensatory. The  ineffability of stillbirth refuses productive understanding. Throughout Birth Prospectus, Riley  is attempting to perform the work of elegiac mourning by transferring  this impossible instant into a narrative that he can understand, but the  text consistently thwarts its own attempts to seek consolation, and in  doing so is a rallying cry of continuing grief. The poem ends, and  persists: ‘Still. Daughter, still.’

Karen McCarthy Woolf’s An Aviary of Small Birds, published in 2014, is a collection of poems structured around the death in childbirth of her son Otto in 2009.12 McCarthy Woolf, too, constructs an almost unbearable pun around ‘still’ in ‘Mort-Dieu’:

Our son

dear God

is dead

and gone.

His tomb

was red

with blood

and warm

as tears.

He was

born still.

Was this

dear God

your will?

Alongside this religious address that questions the purpose of  suffering, McCarthy Woolf — a teacher of creative writing — interrogates  her own role as a writer. In ‘Of August’ she refers to herself  throughout as ‘The Protagonist’, framing her experience as a ‘pitch’ she  plans to submit to a publisher at a later date. Again and again Aviary, like Birth Prospectus, repurposes  natural imagery to situate loss on the border of birth and death. In  ‘Reasons to Fear Butterflies’, the insects are figured as creatures  sustained by ‘feeding’ on human ‘secretions’, on ‘sweat, saliva, tears’,  before being transfigured into infants seeking nourishment from the  maternal body of water: ‘sucking / the sea as if it were a teat’.

This distrust and ‘fear’ applies only to living creatures. In ‘Of  Roadkill and Other Corpses’, the bodies of dead animals are something to  treasure: ‘After the birth she spends a year and a half taking  photographs of dead animals and prizes the most pristine.’ The ‘birth’  is a catalyst for a fascination with the physical specifics of  mortality, as the poem unflinchingly describes the ‘splayed’ legs of rigor mortis,  the ‘gelatinous web’ of ‘disintegrating geese’ and a ‘flattened  rabbit’. In Kate Kellaway’s 2014 review of the collection — referring to  the stillbirth as a ‘tragic non-event’ — she states that ‘Otto’s death  gives birth to the book.’13 Perhaps, but in An Aviary of Small Birds the  distinction is not so easily made. The final two lines of ‘Of Roadkill’  describe the corpse of a pony on a road that cuts through Dartmoor, the  ‘final’ item in this post-partum collection.

The pony’s legs stick up into the air and a cylinder of  dung protrudes halfway out of its anus. The pony’s genitalia are exposed  and she can be identified as a mare.

The pony’s prostate position and the ‘cylinder’ of protruding dung  recall the visceral realities of childbirth, an image compounded by the  gendering of the ‘exposed’ genitalia. ‘After the birth’ corpses cannot  be separated from reproduction and vice versa, as even the creative  effort of the poem becomes instead a litany of mute, substitutionary  losses.

*

This kind of complicated loss is the subject of the nascent genre of  literature that draws on the advances in reproductive technology, and  their casualties. Infertility is often described as a kind of  bereavement, its failure resulting in grief not only for the child, but  for the parental incarnation of the authorial self that might have been.  The late Professor Lisa Jardine, in her 2014 final address as the  outgoing Chair of the Human Fertilisation and Embryology Authority, or  the HFEA, stated that her chief regret at the end of her time chairing  the Authority was her inability to fulfil her ‘personal mission’ of  public engagement, and, concurrent with that, the fair management of  expectations:

My personal mission when I took up the post was, inevitably given my  interests, public engagement — disseminating as widely as possible both  the benefits and disadvantages of all aspects of assisted reproduction.  This proved to be unexpectedly difficult to do. There is an  extraordinarily high level of coverage of any story involving IVF in the  media — celebrity births, tales of miracle babies after years of  trying, and above all, breakthroughs in clinical practice which may  bring hope to thousands wishing for their own child. This is a sector  that trades in hope, and the papers and women’s magazines are full of  encouragement.

Both here and later on in the address, Jardine employs the vocabulary  of economics, establishing that the currency used by the ‘market in  hope’ has a double edge: the trade-off comes when the hope is not  fulfilled, and the procedure instead ‘delivers’ — and I think Jardine  here consciously employs of the terminology of birth — ‘grief and a  sense of failure’.14

This essay is not the place for a sustained engagement with the  ongoing ethical debate about the practice and marketing of IVF; it would  be foolhardy even to try. Instead, it is this use of ‘grief’ to which I  am going to turn. Jardine mentions Zoe Williams’ Guardian  article from September 2013: ‘Where’s all that grief going?’ Williams is  writing after a visit to the Alternative Parenting Show, a growing  event that provides advice on how, according to their website, to make  the ‘dream of having a family a reality’. From 2017, the show will be  renamed ‘My Future Family Fertility Show’. Williams, like Jardine,  interrogates the troubling economy that underpins IVF without ever  losing sight of the prospective parents themselves. It is not only  possible but necessary to think clear-headedly about the ethical  mechanisms of a for-profit fertility procedure, without diminishing for a  single moment the children born through successful cycles. Williams  first locates the ethical anxiety of IVF within a broader societal moral  economy: ‘There is a privatised-gains, nationalised-losses story here,  too, of course — IVF treatment creates the pregnancy. Any complications  to come out of that pregnancy are then devolved to the NHS’.15

The statistics of IVF, tangled up in profit — you are, after all,  more likely to invest a large sum of money in a medical procedure if it  looks like you have a chance of success — also engage directly with  questions about productivity that echo those we have seen asked about  the categorisation of stillbirth. Williams quotes Susan Bewley, a  professor of Complex Obstetrics at King’s College London: ‘I’ve seen  women on the labour ward have two babies at 25 weeks, both die, but  they’re counted as live births because they came out alive. They go into  HFEA figures as live births’. The language of IVF is the language of  productivity — the entire process relies upon the male party, in the  early stages, being able to go into a sterile room in a clinic and  ‘produce’ into a cup — and this is riddled with the threat of a failure.  Bewley, referring to a study showing IVF to be ‘as traumatic as  chemotherapy’, states that ‘It’s a kind of death. We have our somatic  deaths at the end of our lives, but we also have reproductive deaths’.  In Simon Stone’s award-winning new version of Lorca’s Yerma that  ran at the Young Vic theatre in London from July to September 2016, the  protagonist, played by Billie Piper, reacted to the ‘reproductive  death’ of her failure to conceive by committing suicide in her empty  flat.

Complex Obstetrics and Complicated Grief: the inability to have a  child is a kind of self- bereavement, too. How, then, to elegise this  dual grief? As IVF becomes increasingly common, this is becoming a  pressing concern. In October, 2016, the Australian writer Julia Leigh  published her memoir Avalanche, a slight volume documenting her experiences trying to conceive through assisted reproduction.16 In  recent writing about IVF, the possible children that never materialise are referred to with near-consistency as ‘ghosts’, and Leigh’s work is  not an exception: speaking of her desire to use her ex-husband’s sperm,  as they had planned to do during their relationship, Leigh writes that ‘Our child clung  to me like a ghost.’ Later, once she has made the decision to stop  trying, her online search history becomes a kind of virtual revenant,  visiting her with adverts for antenatal products, pregnancy tests,  breast pumps: ‘I was haunted by the IVF’. In a passage detailing the  trauma of her final unsuccessful cycle, Leigh attempts to mitigate the  agony of hope by pre-emptively ‘killing’ her possible child:

To prepare for the abyss I tried to kill my baby. I  deface the little darling, removed its eyes, eye sockets too (pity the  poor mother in Chernobyl whose baby was born with no eye sockets). I  shrank and gnarled its limbs. I laid my umbilical cord around its neck  like a noose. But it never worked. The childling was always resurrected,  smiling, perfect.

Here, the ‘resurrection’ of the ‘childling’ is removed from any  authorial agency: unlike the purposive elegy that aims to reawaken the  dead, Leigh’s violent imagery attempts to render optimism null and void.  There is a kind of magical thinking in this, an anxiety familiar to  many: if you imagine the worst, it can’t possibly surprise you — and you  won’t jinx the chances of the best occurring.

The counsellor Leigh visits, a cliché made flesh, speaks of ‘the  divorce grief’ and ‘the infertility grief’, but never of grief for the  lost child or children. Instead, she covers a piece of paper with black  dots representing these griefs, before connecting up the dots and  turning them into a butterfly. Outside of this episode, productivity is  one of the conceptual threads that draw the text together. Throughout,  Leigh is open about the costs of IVF, often detailing the precise amount  of each procedure, and aware of her own financial privilege in being  able to afford them. But she questions the vocabulary that situates the  process within a market, comparable with other transactions: ‘Once on  the phone a friend unwittingly said something hurtful. I was moaning  about the high cost of IVF and she said, ‘I know, my sister had to sell  her house to buy her kids’. Buy her kids. Referring to friend who had a heart operation, she notes that ‘No-one ever said he had to buy his life’.  Yet Leigh never really allows her work to discuss the potential unease  that stems from the intersection of grief, productivity and transaction  in the assisted reproduction process. Avalanche is a work of mourning that, despite moving towards consolation in its final pages, never fully contemplates the elegiac.

Rachel Cusk reviewed Avalanche, alongside Belle Bogg’s IVF memoir The Art of Waiting, for the New York Times  in September, 2016. Cusk’s identifies Leigh’s need to turn grief into  narrative as having more to do with the desire to write itself. Cusk  compares IVF to the relatively new academic discipline of Creative  Writing and, speaking from the idealised positions of both a mother and a  successful writer, questions the effect of this desire to occupy a  role:

To be a writer, to be a mother: The more these desires  are separated from their object (to be the writer of what, to be the  mother of whom?), the more they seem to represent not the reaching out  of creativity but the inward obstinacy of personal will.17

Avalanche, she continues, is ‘a harrowing and profoundly  disturbing account of self-immolation in pursuit of an ideal’. Whilst  Boggs focuses on the complex relationship between motherhood — what we  might term biological productivity — and writing, drawing heavily on  Virginia Woolf’s notes on childlessness, Leigh dismisses such concerns  out of hand. Being a writer and being a mother, she declares at the  beginning of Avalanche, is ‘not rocket science’. Adrienne Rich, in her seminal 1976 Of Woman Born: Motherhood as Experience and Institution, describes pregnancy as, for most of history, a kind of ‘forced labour’.18  The organisation FINNRAGE, or the ‘Feminist International Resistance to  Reproductive and Genetic Engineering’, declares assisted reproduction  to be a furtherance of the utilisation of women’s bodies as a capitalist  productive tool. These are provocative generalisations, but Leigh’s  refusal to engage with the complex transactional, gendered economics of  reproduction renders the very work of mourning unacknowledged and  devalued.

Cusk identifies the improvements in medical reproductive technologies  as the catalyst for a new understanding of what the complicated grief  of childlessness can be, and how it can be articulated:

One problem with the discourse of infertility is that it  has at its core a non-event. How can a woman talk about or learn from  what hasn’t happened to her? The advent of I.V.F. has brought more than  new technologies and hope to that expressive impasse: It has made  infertility experiential, an active state with its own narrative, its  own sufferings and hence — one anticipates — its own wisdom.

This use of ‘non-event’ calls to mind once again the ontological  stasis occupied by stillbirth, the ‘expressive impasse’ that heightens  when even the most extreme emotional state cannot quite be translated  into narrative sequence. It’s true that Leigh’s narrative is, at points,  jarringly myopic. Unlike Riley, who explicitly states ‘Never would I  compare my state with that of, say, a widow’s’, Leigh does attempt to  create a hierarchy of grief, or at least one of guilt: ‘Doubled grief:  lost marriage, lost childling. I envied the widows — innocent — whereas I  was complicit in my loss.’ Ironic moments like her discussion of her  ‘nurse fetish’ fall flat, the explanation of which — ‘“the nurses” were a  kind of timeless ideal, swap out one nurse for another and the nurses  would remain untouched in their humble glory’— reads like an unfortunate  pastiche of a similar section in Gillian Rose’s masterful Love’s Work.  Leigh’s unswerving commitment to her own narrative denies her the  opportunity to explore the polyphony of other grieving voices, denies  her the ethical perspective that comes with empathy. ‘I envied the  widows’. Yet her conflation of motherhood with ‘purpose’ is an honest  one:

There is a comfort in purpose. Part of me wanted to have a  child just so I could have an inviolable reason for being. Sweet  purpose. Sweet dark purpose, secret of secrets. A child would save my life.

Whether this ‘purpose’ is rightly or wrongly located in the idea of a  potential child is, for our purposes, beside the point. Leigh, who  writes at the very beginning of her ‘destined child’, believes that she  was supposed to be a parent. The loss of the imagined, desired,  paid-for child is, like in all parental elegy, a subversion of the  natural order of things. If the child cannot ‘save’ her life, then  consolation must be sought in writing: like Ramazani’s identification of  the change in elegiac thinking that came with the secularisation of  society, medical advances are altering our notions of what life itself should look like.