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MHCs' awareness of the following common losses experienced by children (Goldman, 2000b) can give insight into the complexities of children's grieving process. In addition to the types of losses that come easily to mind, like the loss of a family member or friend, children experience more subtle or less obvious losses. Other relationship losses include the absence of teacher or a parent being unavailable due to substance abuse, imprisonment, or divorce. Children experience loss of external objects through robbery or favorite toys or objects being misplaced Self-related losses include loss of a physical part of the body or loss of self-esteem perhaps through physical, sexual, emotional, or derivational abuse. Many children live with loss in their environment including fire, floods, hurricanes, and other natural disasters. A primary death can often create the secondary loss of a move, change of school, change in the family structure, or family separation. Other childhood losses are loss of routines and habits and loss of skills and abilities after the death of a close loved one. Lastly, the loss of a future and the protection of the adult world are common experiences for the grieving child, causing them sometimes to exhibit a lack of motivation and an inclination to choose violence as a way of solving problems.
Children's Developmental Understanding of Death
Piaget's next stage of development, concrete operations, usually includes ages 7-12 years (Ginsberg, & Opper, 1969). During this stage the child, in relation to death, is very curious and realistic and seeks information. Mary, at age 10, wanted to know everything about her mother's death. She stated that she had heard so many stories about her mom's fatal car crash that she wanted to look up the story in the newspaper to find out the facts. Jason, age 11, wondered about his friend who was killed in a sudden plane crash. "What was he thinking before the crash, was he scared, and did he suffer?" Tom age appropriately wondered at age 9 if there was an after-life and exactly where his dad was after his sudden fatal heart attack. These examples illustrate that, at this stage of development, children commonly express logical thoughts and fears about death, can conceptualize that all body functions stop, and begin to internalize the universality and permanence of death. They may ponder the facts about how the terrorists got the plane to crash, wanting to know every detail. When working with this age group, it is important to ask, "What are the facts that you would like to know?" and to assist children in finding answers through family, friends, media, and experts.
Adolescents' (age 13 and up) concept of death is often characterized in accord with Piaget's prepositional operations, implications, and logic stage of development (Ginsberg, & Opper, 1969). Many teenagers, being self-absorbed at this age, see mortality and death as a natural process that is very remote from their day-to-day life and something they cannot control. Teenagers are often preoccupied with shaping their own life and deny the possibility of their own death. Malcolm, 16 years old, expressed age-appropriate thoughts when he proclaimed, "I won't let those terrorists control my life. I'll visit the mall in Washington whenever I want. They can't hurt me!"
Children can misinterpret language at different developmental stages. The young child can misunderstand clichés associated with grieving, and these clichés can actually block the grieving process. Sammy, at age 6, began having nightmares and exhibited a fear of going to sleep after he was told that his dog Elmo died because "the vet put him to sleep." Alice was told it was "God's will" that her grandmother died because "God loved her so much." Alice questioned, "Why would God take Grandma away from me, doesn't God love me, and will God take me too?" Tom, age 9 years, continually heard the message that dad was watching over him. One day he asked the mental health clinician, "Do you really think my dad is watching over me all of the time? That would be very embarrassing."
Talking to Children About Death
Reflection Exercise #2
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