A clinical ethnography
At the invitation of the Sygne editorial board, I dove back into research that I conducted about ten years ago, while I was practicing as a clinical psychologist in Seine-Saint-Denis, an underserved area on the outskirts of Paris. My clinical time was split between the family planning consultation, the maternity, and the gynecology unit of a public hospital. Doctors and health workers often referred patients to me when they reached the limits of what they knew to say. In particular, they directed patients to me when confronted with a bleaker side of maternity, stillbirth or late medical termination. My work with expecting or recent parents came to focus on families experiencing loss in a moment when life was expected. I turned to psychoanalytic anthropology to make sense of what I was witnessing, and joined the University of Paris Diderot/CNRS research laboratory then called « Psychoanalysis and Social Practices ». With Paul-Laurent Assoun, I took part in an interdisciplinary research team on « Bodies and the city », for which I presented a report on the liminal inscription of fetal death in the city. I then defended a thesis directed by Markos Zafiropoulos, titled « Porter la mort de l’autre en soi: Le deuil de maternité » (Bearing the other’s death: mourning maternity).
Using my own clinical practice as an ethnographic source allowed a deep engagement with the complexity of the psychic and social work at play in mourning a death before birth. Engaging in a clinical ethnography gave me unique psychological insights, but restrictions emerged from this method: it didn’t allow me to engage with mothers who didn’t come to talk therapy. For such insight, I refer to the ethnographic work of Rayna Rapp, who elucidates the political and social factors structuring the positions of women grappling with reproductive choice, which she calls « moral pioneers ». Despite these limitations in my past work, and having turned to entirely different questions in my research since then, I am happy to revisit the question of mourning maternity, and offer new perspectives on it. Writing about this topic is delicate. As a defendant of reproductive choice, I cannot evacuate the fact that the idea of grief after pregnancy loss is often weaponized against women’s rights. As a Disability Studies scholar, I know that the ethical implications of prenatal screening weigh heavy. Yet, I believe it is essential to engage with the complexity of the experience of mothers.
I start this article with the story of the therapeutic work of a woman I have renamed Mary. In our weekly therapy sessions over eight months, Mary grappled with the grieving of a child she could not bear to term, and confronted public instutions on their ambiguous registering this relation. The uneasy inscription with which Mary – and many other parents – struggled led me to the cemetery of Thiais, where a controversial space for fetuses was negotiated in the early 2000s. After a visit of the cemetery and its public « garden of memory », I question the historical conditions of inscription of those who passed before coming to life, and reflect on the ontological status of the fetus. I question what is lost with the fetus, and what this experience of loss reveals about our relationship to liminal presences and objects.
Mary entered my office with a big file in her hands. « Do you want to look at this? The doctor told me to come see you », she said as she sat down in my office, dropping her medical file onto my desk as if she wanted to rid herself of it. 24-weeks pregnant, she had just been informed that the baby she carried was diagnosed with a genetic anomaly, and was instructed of the possibility to terminate her pregnancy. She didn’t quite expect to be there, holding that kind of news, but now she was trying to imagine the next steps. She sat for a while in silence, before explaining to me that she was already quite sure she would terminate her pregnancy, even though she perceived this act as « crude and violent ». She was in a paradoxical position toward her decision: she stated that it was her « only logical choice », but distanced herself from it: « I wanted to keep her, but medicine decided otherwise ».
Nearly forty years old at the time, she already had two children with her husband, and had lived this third pregnancy as an unexpected and hopeful return to maternity. As a working-class mother who was about to start work again, to have a new baby would have allowed her to stay at home longer. She was very proud of her function as a primary care-taker, which she wanted to keep, but she saw this future come to a close with the termination she was about to choose.
When Mary came to her next appointment a week later, she was programmed to give birth to her child, whose heart had already been medically stopped. She remained mostly silent during our encounter, but asked that I visit her hospital room a few of days later. After the birth, she told me she declined to go to the morgue: « I sent my husband because I was afraid my baby looked monstrous. Even now that my husband has seen her and reassured me, I can’t ». She stopped talking, as if in a state of heightened stupor, riddled with feelings that were still unspeakable. « It seems that what you are feeling right now exceed what you can think », I told her. « Maybe you can come try to make sense of this when you are ready? » She nodded in agreement. We met weekly for the next eight months.
At first in a state of shock, Mary kept repeating a factual narration of the events she went through. She regretted « not to have had the strength » to hold her daughter in her arms and say goodbye. She also judged herself severely for deciding to let the hospital take care of the remains, and since then for not being able to go the cemetery. She gave me a letter addressed to her daughter, because she had « nowhere to leave it ». Our sessions were invested as a substitute to her sepulcher. She explained this was one of the only spaces where she could talk about her grief, because I had been a witness of that moment. She also dedicated a box to the memory of « her angel », in which she isolated keepsakes from her, so that they didn’t « invade her life ». By containing her grief, she also isolated herself from those she perceived as unable to understand her.
After two months, she eventually decided to visit her daughter’s resting place. She imagined she had a sepulcher at the local cemetery, but discovered instead that her remains had been placed in the distant cemetery of Thiais. Furthermore, what she had imagined as the grave of her baby was in fact a collective space, without any individual acknowledgement, or even a dedicated space for children. Her daughter had been cremated by the hospital, and her ashes had been deposited at a common site called « the garden of memory », in a faraway cemetery. She became tormented by this lack of inscription, and entered into a war with public institutions. During the following couple of months, her anger dominated her life and our sessions. She entered in a dispute with the city because they omitted to mention her baby in the notifications of births and deaths. She was also angry at her husband for not ordering an inscription to leave at the cemetery, but couldn’t bring herself to talking about it with him.
Her « request toward the State », as she articulated it herself, was also, in a parallel movement, addressed to a much more intimate audience. She battled with the hospital and the city hall, even considering filing a legal suit, but discovered another recipient of her blame as our sessions went by. She was angry that her parents, and especially her mother, refused to acknowledge her loss as the loss of a child. Through their actions, she felt that they denied its inscription in the family. Directing reproaches towards others allowed her at first to move away from the anger she felt towards her family. This interpretation, which she formulated herself, was a turning point in our sessions and in her experience of her grief.
The therapeutic work made Mary perceive another origin for the conflicts she enacted after the termination of her pregnancy. The centrality of her anger in grief became the occasion to understand the centrality of the rivalry with her brothers in her life, and fraught relationship with her mother. She realized she used a conflict with her brothers to gain distance from her mother, whose toxic influence had overshadowed her life. Despite years and distance, Mary still waited for a validation that her mother was unable to give.
As Mary terminated her pregnancy, she lost the promise of a child, as well as her social recognition as mother in the eyes of her own mother. This intimate loss was amplified by its lack of social inscription, and she directed her anger towards public institutions. Mary blamed the hospital for not following through on its promise to « take care » of her daughter. While she was not sufficiently informed about what would become of her remains, she realized that she also didn’t want to know at the time, and could not imagine giving a burial to her daughter. It took her time to think through the ambivalence of her demand. She could not bring herself to inquire about the specific conditions with which the hospital was going to dispose of the remains at the time when she signed a waiver deferring this responsibility to them.
While it is essential to situate reproductive choices within the neoliberal logic of both individual responsibility and eugenics, I move here in another direction. Through the story of Mary, I examine the social and psychic entanglements of late-term pregnancy termination. While Mary didn’t regret her decision to terminate her pregnancy, she grappled with her paradoxal desire to both let go of, and hold onto her lost child, manifested in her initial refusal, and her later desire to give it space. This found echo both in a lack of recognition by her own mother, and in the anonymous treatment of fetal remains by the hospital and the state. When she thought she had passed on to the public hospital the responsibility to bury her child, she had in fact given way to the erasure of its passing, through the disappearance of any material link with it. Mary’s discovery led me to question the hospital about treatment of remains, and pushed me to give more attention to the social conditions of burial, initiating my venture outside of the consultation room. It led me to the cemetery of Thiais, and to historical practices surrounding perinatal death.
An inscription at the margins
Set in a faraway working-class suburb of Paris, the cemetery of Thiais is a liminal space where people from the whole greater Parisian area are buried, when they die without next of kin, or if their family cannot afford a burial. Being buried in this cemetery often carries important connotations of class, race and social status. Families trying to visit the cemetery experience the distance separating this space from the rest of society, as it is isolated from urban centers, and requires a long commute to be reached. Within the cemetery, two distinct collective memorial spaces exist, reflecting different institutional approaches to the burial of babies who died before birth.
The first space is dedicated to stillborns and fetuses from Parisian hospitals, and was built after advocacy by the psychologist Jean-Pierre Legros, and the discovery of a collection of fetuses in the archive of the Hospital Saint-Vincent-de-Paul. In the 1990s and 2000s, mental health professionals advocated for improved clinical protocols regarding perinatal death. They recommended that parents be encouraged to see and hold their babies, that portrait photographs be added to the medical files for later access by parents, and that individualized sites of burial be arranged when parents delegate the handling of remains to hospitals. Parents from Parisian hospitals who leave burials to the care of Parisian hospitals now know that babies will have a specific and identifiable burial site for five years. Some graves end up being appropriated by families and have headstones or flowers, but many others have no signs of family visit
Parents of non-Parisian hospitals have to turn to a second space, a memorial dedicated to « gifts to medicine », which receives only cremations. The memorial figures a large grassy area, with a monument to « the gift of bodies to science » in the middle, on which signs by several hospitals and universities are apposed. Rows of shrubs surround the monument, and myriads of votive offerings, plaques, flowers, toys, and stuffed animals lay at their feet. The messages left there commemorate both children and adults, but certain spaces gather more plaques and offerings in memory of children, showing that mourners aim to constitute an identifiable place for them within the loosely-structured square of the memorial.
This « garden of memory » may not live up to the representations that parents have of their baby’s resting place. For Mary, this space of (un)burial came to symbolize the impossible inscription of her experience in the social and familial realm. While many parents and psychologists advocate for more recognition and inscription, I argue that the fetus, tenuously existing at the threshold between life and death embodies a liminal state that no burial solution can fully mitigate. In my clinical work, I noticed that parents who consulted regarding late-term pregnancy loss often expressed their pain through recriminations towards the State about the modalities of burial and limits of recognition, while at the same time often refusing to organize a burial on their own. They often developed an intimate relationship with the workings and regulations of the State, through which they expressed the difficulty to affirm their loss as the loss of the child in the eyes of their friends and families.
Given this paradox, I set out to investigate historical treatments of perinatal mortality, to see whether a tension between the State and parents about stillbirth had a longer history. Since burial customs were long determined by the Catholic Church in France, the history of stillbirth is intertwined with the history of Catholicism in this context. Between the 12th and 18th century, numerous historical studies show that while the Church was reluctant to allow children without baptism into both the physical space of the cemetery and the eschatological space of heaven, it conceded to parents the creation of the limbo of children, and the practice of sanctuaries for respite.
The Ecole des Annales historian of the High Middle-Ages Jacques Le Goff argued that the geography of the after-life shifted at the end of the 11th century, to accommodate both a purgatory and two limbos, following new beliefs about the understanding of sin. In order to « soften » the fate of children dead without baptism, they were placed in a permanent intermediary space. The limbos were later captured by Dante in the following terms:
There, as it seemed to me from listening,
Were lamentations none, but only sighs,
That tremble made the everlasting air.
And this arose from sorrow without torment,
Which the crowds had, that many were and great,
Of infants and of women and of men.
That they sinned not; and if they merit had,
‘Tis not enough, because they had not baptism
Which is the portal of the Faith thou holdest;
For such defects, and not for other guilt,
Lost are we and are only so far punished,
That without hope we live on in desire.
A lesser but eternal pain was conferred to children without baptism who, in the limbo of children, only suffer from the « privation of the vision of god » – a pain of consciousness demarcated from the physical pain of hell. The Church sanctioned the absence of baptism, but didn’t condemn anymore the souls of stillborns. The creation of a Limbo of the Children aimed to circumscribe the exclusion of children without baptism to a specific place in order to both prevent animist practices that had previously been common, and to fend against contestations of the importance of the original sin.
In this compromise, the cemetery remained a space reserved for those with baptism. Parents who rebuked against this new form of exclusion kept searching for theological solutions to overcome it, leading to practices such as in utero baptism and sanctuaries for respite. Sactuaries for respite spanned from 11th to 19th century Europe, with an important expansion and institutionalization in the 14th century. Despite temporal variations in different countries, this practice was well spread across Eastern France, Belgium, Switzerland, Austria, Germany and Northern Italy. It allowed the redemption of the soul of the stillborn, as well as the integration of its sepulcher in the sanctified space of the cemetery:
One would resign to physical death, but not spiritual death, because a tragic destiny expected the soul of the stillborn. Only a miracle, the apparitions of « signs of life », authorized the baptism, as it was sacrilegious to baptize a dead. Yet, those miraculous signs would appear only in certain circumstances, thanks to the intercession of the Virgin or a saint, either in the domestic space at the moment of birth, or in chapels or parochial churches in the following hours or days. Such signs were the tangible mark of a « respite », giving the time to baptize the child before its death, this time definitely ; hence after, he was given a sepulcher in Christian land.
Two forms of respite existed at first : the domestic respite, occurring often at the place of birth, and the respite in a sanctuary, often at a place of pilgrimage dedicated to the figure of Mary. In an effort to better control the conditions in which sacrament is given, the Church privileged sanctuaries for respite. While very present in cities from the 13th to the 15th century, respites became massively rural after the Catholic Counter-Reform in the middle of the 16th century. As sanctuaries for respite came to be severely judged and pushed to zones where the religious hierarchy had lesser control, the Church allowed the burial of children dead without baptism in a non-sacred corner of the cemetery:
The decision taken by the Council of Trent allowing to bury children dead without baptism in a non-sacred corner of the cemetery appear as a compromise between a necessary exclusion on the theological level, and a useful integration for the parental memory. The absence of Christian sepulcher of the child dead without baptism is the social mark of its impossible salvation. Its body, banished from the ancestral land, is the reflection of its soul lost forever to paradise.
The banishment marked a rupture within filiation, a definitive separation often unacceptable to parents, as documented through cases of exhumations after too swift burial in this separate space. Mothers demanded the exhumations in order to bring the stillborn babies to sanctuaries for respite, hoping of obtaining their proper inscription in the afterlife and in sacred grounds. With the respite, the child was considered given a second, spiritual, birth, and often a second mystical filiation. It was thus often buried at the site of the miracle, until this practice was banished from religious sites in the 18th century, at the same time as cemeteries became relegated to the outskirts of cities.
Through the study of the inscription of children dead before baptism – both in the cemetery and in the hereafter – in French Catholic history, we grasp at how parents’ demand for recognition have shaped both ritual practices and the geography of burial. Historically, both the State and the Church were compelled to hear parental demands, while at the same time continuing to define the limits of life. Death before birth is a peculiar and yet common phenomenon, an experience at the limits of life. What are the consequences of looking at the fetus as an ambiguous loss, rather than dvocate for its inscription as a subject? What becomes of this ambiguity, and the trouble it triggers ?
From attachment to liminality
The American medical anthropologist Lisa Malkki analyzes the discursive construction of the child in humanitarian campaigns as a pure good, truth, sufferer, and embodiment of the future, always outside of political positions, which lends a rhetorical « affective authority » to advocacy. She argues that the domestication of childhood in humanitarian rhetoric brought a « domestication of hope ». Adopting a parallel deconstructive movement, I call for the rethinking of the figure of the dead child, and call for other ways of approaching mourning and the inscription of loss. While Malkki argues for a relational analysis of children in their modes of engagement with the world, other children, adults, objects, but also time, geographies, I argue for a relational analysis of mothers in their solicitations of the world, their families, institutions, but also traces of the brief presence of their babies in (un)burial grounds.
Through Mary’s experience and the history of death before baptism, we come to grapple with a form of presence which isn’t ex-istence, not being in the outer world. This analytic movement allows us to move away from the authoritative rhetoric of life, which often surrounds debates on the ontological status of the fetus, and remain with the trouble raised by the experience of stillbirth. How to inscribe that which promised to be, that which manifested itself, but which never fully came to be, which never fully existed in the social realm ? If we develop an anthropology that does not take humanity as a granted fundament after which other elements are organized, what then takes central stage ? Rather than personifying the fetus, could we think of it as an object of desire, or an object that cannot fully be grasped, and remains liminal because of its position as a lack?
Psychoanalysis might help us precisely on this question, as it offers an understanding of psychic processes not based on a figure of the human, but rather on mechanisms, drives, and objects of desire that elude us. In Lacanian terms, another object, the object a, takes center as a presence of the absence, representing the lack around which desire is deployed. Irremediably escaping and always missed, it is also always present. It inscribes the coordinates of desire as relative to a void at the center of the subject. In this sense, Mary’s encounter with loss can be understood as the actualization of a long-present catastrophe, which constitutes her as subject. Its reoccurrence and actualization calls her to explore the different layers though which she experiences and defines herself.
Both in the clinic and in burial grounds, giving a central position to the idea of lack may help us move away from the image of the idealized child, and open to a space, both physical and psychic, where ambiguity and ambivalence remain tolerable. The attention to desire, ambivalence, and what elides might allow us to give central stage to what cannot fit, what haunts and remains other in social constructions. Through the experience of fetal death, we can think of the possibility of an ethnography where lacks, emotions, voids are given central stage, an anthropology that would allow space for the un-mastered to emerge. The desire for recognition and social inscription that Mary shared can thus be revisited as a second scene, where essential demands are replayed. This analytic shift can help us move beyond an anthropocentric worldview, where the agency of both objects and absences is recognized. It invites us to move away from the position of the therapist as patient’s advocate, and move to consider the symbolic and social conditions of loss.
 R. RAPP, Testing Women, Testing the Fetus, New York, Routledge, 1999, p. 307.
 This ontological ambiguity is perceivable in the variety of terms used to name it. If the doctors talk about a fetus, parents and midwives talk about a baby or a child. I switch between these two registers based on the realm I am engaging with.
 French law distinguises between two types of abortions : Interruption Volontaire de Grossesse (IVG, voluntary pregnancy termination) are allowed until the end of twelve weeks of pregnancy without justification. Interruption Medicale de Grossesse (IMG, medical pregnancy termination) are allowed until term, in case of medical concerns regarding either the fetus or the mother.
 J.-P. LEGROS, « “Avenue I, division 102”. Le devenir des corps au cimetière parisien de Thiais ; un parcours initiatique » in C. LE GRAND-SEBILLE, M.-F. MOREL, F. ZONABEND, Le Fœtus, le nourrisson et la mort, Paris, L’Harmattan, 1998, p. 199 ; C. MANAOUIL, M. DECOURCELLE, M. GIGNON, O. JARDE, « Retour sur « l’affaire » des fœtus de la chambre mortuaire de l’Hôpital Saint-Vincent-de-Paul à Paris », Journal de médecine légale et de droit médical, 2007, vol. 50, no4, p. 231-237.
 G. DELAISI de PARSEVAL, « Les deuils périnataux », Etudes, n°387-5, novembre 1997 ; M. DUMOULIN, A.-S. VALAT, « L’enfant décédé en maternité : un rituel réinventé », in C. LE GRAND-SEBILLE, M.-F. MOREL, F. ZONABEND, op. cit. ; M. FELLOUS, A la recherche de nouveaux rites, Paris, L’Harmattan, 2001 ; S. FOURNIER « Le patrimoire, la mort et le temps : logiques de deuil et de résurrection symbolique », Malmorts, Revenants et Vampires en Europe, Paris, L’Harmattan, 2005.
 J. LE GOFF, « Les Limbes » Nouvelle revue de psychanalyse n°34, 1986 ; D. LETT, « De l’errance au deuil. Les enfants morts sans baptême et la naissance du Limbus puerorum aux XIIe-XIIIe siècles », in FOSSIER, La Petite enfance dans l’Europe médiévale et moderne, Toulouse, Presses Universitaires du Mirail, 1997 ; J. GELIS, Les Enfants des limbes. Morts-nés et parents dans l’Europe chrétienne, Paris, Audibert, 2006.
 J. LE GOFF, La Naissance du Purgatoire, Paris, Gallimard, 1981, p. 288.
 DANTE, Inferno, Canto IV, v. 25-43, accessed at http://danteinferno.info/translations/index.html.
 J. LE GOFF, « Les limbes », op. cit., p. 166.
 D. LETT, op. cit., p. 88 ; M.-F. MOREL, « La Mort d’un bébé au fil de l’histoire », Spirales, n°31, 2004, p. 22.
 J. GELIS, M. LAGET, M.-F. MOREL, Entrer dans la vie, naissance et enfance dans la France traditionnelle, Paris, Gallimard/Julliard, 1978, p. 100.
 J. GELIS, op. cit., p. 7-8 (my translation).
 Id., p. 271.
 D. LETT, op. cit., p. 212-213.
 L. MALKKI, « Children, Humanity, and the Infantilizatoin of Peace » in L. FELDMAN, M. TICKTIN, In the Name of Humanity, Durham, Duke University Press, 2010, p. 74.
 Id., p. 77.