"Experts Offer Fresh Insights Into the Mind of the Grieving Child"
by Erica Goode The New York Times, March 28, 2000
"When her father died from leukemia, 3-year-old Rachel asked her mother, 'When is he coming back?'
Mark, 7, complained of chest pains after his father died, and took to wearing his father's boxer shorts and ties. 'He is gone, kaput, he's dead,' Mark explained to a family friend.
Hillary, 12, was embarrassed when her mother cried at her father's funeral, and refused to visit the cemetery in the weeks afterward. 'Crying won't help,' she said. 'Why should I go to the cemetery? I talk to my father all the time anyway.'
Sigmund Freud believed that young children did not have the capacity to mourn: The psychological tasks involved in resolving grief, Freud asserted in 'Mourning and Melancholia,' are too difficult for children to negotiate. Only in adolescence, when development is more advanced, does true grieving become possible, he maintained.
But a new book, based on a large-scale study by researchers at Memorial Sloan-Kettering Cancer Center of families coping with the illness and death of a parent, offers a very different understanding of children's ability to come to terms with loss.
In 'Healing Children's Grief: Surviving a Parent's Death From Cancer' (Oxford, 2000), Dr. Grace Hyslop Christ, an associate professor in the School of Social Work at Columbia University who was one of two principal investigators in the Sloan-Kettering study, makes it clear that children, even very young children, do grieve, though their grieving differs at different ages, and often bears little resemblance to the mourning reactions of adults.
More important, Dr. Christ, who gave her young subjects pseudonyms in her book to protect their identities, found that given adequate support and assistance, most of the children were able to move on with their lives, without developing serious psychological problems, at least for the short term.
'Society tends to think about this experience as either devastating to children, that they should be kept from it, or the opposite, that kids are resilient and will bounce back on their own,' Dr. Christ said. 'But we found that while children do go through pain, they can also learn, grow and recover with the help of supportive adults.'
Over the past decade, investigators have begun to gain a greater understanding of the impact of losing a parent early in life. Some studies have tackled the topic retrospectively, interviewing adults about their early experiences. Others, like the Sloan-Kettering study, have charted children's reactions as they unfold.
What is apparent from such studies is that losing a parent is not a single event, which then has predictable consequences for the child. Rather, the way a child responds to the loss is the result of a complex interweaving of circumstances, including the emotional responses and parenting abilities of the surviving parent and the presence or absence of other stressors -- financial difficulties, for example, or the death of another family member. Much also depends on the child's own natural strengths and weaknesses, and the child's changing relationship with the dead parent over time.
'I think a kid is as vulnerable as his parents and the support system around him,' said Dr. Phyllis Rolfe Silverman, author of 'Never Too Young To Know: Death in Children's Lives' (Oxford, 1999), and co-director of the Harvard Bereavement Study, a long-term study of 125 children who had experienced the death of a parent.
In some ways, the Sloan-Kettering study, led by Dr. Christ and Dr. Karolynn Siegel, offers a best case example. They and their colleagues followed 157 children, aged 3 to 17, through the parent's illness and for 14 months after the death. The researchers not only studied the 88 families involved, administering a battery of psychological tests and interviewing the parents and children, as well as teachers and other family members in some cases, but they offered the families help, providing educational counseling and support in the months leading up to the death and afterward.
For example, the researchers offered parents suggestions of ways to handle problems with their children if such problems emerged, and talked with the children themselves about what they were feeling and thinking. Children who had known psychiatric problems before the parent fell ill were excluded from the study, since it would be difficult to tell if later difficulties were related to the parent's death.
Under these conditions, most of the children who took part in the study did relatively well. Of the 139 children above preschool age, for example, 84 had returned to normal levels of functioning at school and in relation to other family members and their peers by 8 to 14 months after the parent's death. Another 32 were functioning normally in all but one area, and were improving in that area.
The remaining 23 children were either experiencing difficulties in two or more areas and showed no sign of improvement, or had developed new psychological symptoms since the parent's death.
Children of different ages, Dr. Christ and her colleagues found, coped with the parent's illness and death in very different ways.
Preschoolers, from 3 to 5, had the most difficulty understanding the irreversibility of death, even when they had been told ahead of time that the parent was going to die. For weeks, or even months after the death they would ask when their mother or father was coming back, and they often needed very concrete explanations of what death meant; for example, that the body no longer functioned, and that death made people feel sad and cry.
Once the children accepted that the parent would not return, they often showed signs of distress, including night terrors, bed-wetting, whining, stomachaches and intense anxiety when separated from the surviving parent. They were upset when the surviving parent showed strong emotions, and soon after the death, many began to demand that their lost mother or father be replaced.
Rachel, for example, told her mother, 'I don't have a daddy, but everyone else has a daddy.'' She offered to be her mother's husband, but her mother replied, 'You are my daughter and I really want you to be my daughter.' Rachel then suggested that perhaps their housekeeper could be her mother's husband, and when told that would not work, nominated the husband of her mother's best friend.
Slightly older children, from 6 to 8, were generally quick to appreciate the permanence of death, but they were also likely to conclude that they were responsible for the death, or to draw other illogical conclusions about what was happening. An 8-year-old girl in the study, for example, did not want to talk to the researchers about the probability that her mother would die: she was afraid that talking about it would make it happen.
'It's a very vulnerable age,' Dr. Christ said.
Many of the children talked explicitly about wanting to die to be with the lost parent. But such statements, Dr. Christ said, usually represented intense longing and an expression of grief rather than suicidal feelings. At the same time, the children loved to talk about the deceased parent and to tell stories about things the family had done together. One child, for example, cherished the memory of how her mother squeezed her hand on the day she died.
For children from 9 to 14, the process of mourning was more complex and also at times more frustrating for the surviving parents. Many preadolescents felt in danger of being overwhelmed by the pain they experienced. As a result, they often shoved their feelings away and were reluctant to talk about the death, preferring to escape into school activities or visits with friend.
Adolescents 12 to 14 were sometimes the hardest for the surviving parents to reach. Their egocentricity could be shocking to parents coping with their own grief: told of her father's diagnosis, a 13-year-old went out to a party with friends. 'What was I supposed to do?' she said to her mother. 'Stay home and cry?'
Most did not want to talk about the parent's death or to learn about the nature of the illness. One boy told his mother, who kept trying to keep him informed about his father's condition, 'I want a report every three days unless something else happens.'
They missed the parent as a caretaker and also as a role model. But they hated the idea of showing emotion. 'The mantra of this age group was 'I cry, but in my room alone,' ' Dr. Christ said.
It was the oldest children in the study, she continued, those from ages 15 to 17, who most resembled adults in their approach to death. Many went through a sustained period of grief immediately after the death. They were able to be helpful and supportive to surviving parents -- sometimes so much so that the parent forgot that the child was still a child.
For all age groups, the researchers found, children who adjusted most successfully had parents who were communicative and shared information about what was going on. Children in families where the parents refused to acknowledge or deal with the death, or where the loss was compounded by other stresses -- money, the illness of other family members, a surviving parent's plunging into severe depression -- had more trouble coping. In many cases, children in the study reported more stress and anxiety in the period before the parent died than afterward.
Dr. Albert Cain, a professor of psychology at the University of Michigan who has studied bereaved children, praised the Sloan-Kettering study for its insights into the ways children deal with a forthcoming death.
But he pointed out that because of the counseling offered to the families, it was difficult to tell how much of the later adjustment of the children was due to the intervention and how much to other factors, like the passage of time.
And he cautioned that there was still much to learn about the long-term effects of the death of a parent in early life.
'I think we're all agreed that no one walks away from that without enduring scars,' he said, 'but the issue is the extent to which you get continuing -- if not escalating -- interference with development or distortions of adjustment.'
Still, Dr. Christ said that one of the most interesting findings of the study was that some parents who had serious psychological difficulties before a spouse died still managed to pull themselves together and prove very effective in parenting their children after the death.
And while many dying parents worried that their children would remember them in the worst stages of their illness, Dr. Christ found that more often, the reverse proved to be true.
'Children really focused on the positive aspects of the parent,' she said, and they often worked to construct an image of the parent that they could remember and take with them into their later lives.
''Children Discuss Death''
The following are quotes from childern dealing with the death of a parent, from the book 'Healing Children's Grief' (Oxford University Press, 2000)
The nine-year-old felt that it was unfair that 'Dad's in Heaven, flying around and doing anything he wants and I have to work.'
A 7-year-old girl prayed that God would take her mother so that she would not suffer so much. The next day her mother died and the child said, 'I think I killed her.'
Preschool children were easily overwhelmed by their parent's intense emotional reactions to the illness. At age three years, Rachel...informed her mother after they had cried together that 'Two people can't cry at the same time and I was crying first.'
After 13-year-old Beth was told about her father's diagnosis in the afternoon, she attended a party with friends that evening. 'What was I supposed to do??' she asked when her mother inquired, 'Stay home and cry?'
The mourning of middle adolescents (15 to 17)...was more like that of an adult but did not last as long. 'I'm trying to deal with two things at once -- help my mom and help myself. It's hard but I'm toughing it out,' said Donald, 16."