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Fox (1988) explained that one useful way to help bereaved children and monitor their ongoing emotional needs is to "conceptualize what they must do in order to stay psychologically healthy" (p. 8). Fox emphasized that, in order to assure children's grief will be good grief, they must accomplish four tasks: understanding, grieving, commemorating, and going on. Each child's unique nature and age-appropriate level of experience can influence how he or she works through these tasks. The specific cause of death can also influence the way a child accomplishes these tasks. A dad's death by suicide may create significantly different issues than an anticipated grandfather's death from pneumonia.
Bereaved children may not process grief in a linear way (Goldman, 2000b). The tasks may surface and resurface in varying order, intensity, and duration. Grief work can be "messy," with waves of feelings and thoughts flowing through children when they least expect it to come. Children can be unsuspectingly hit with these "grief bullets" in the car, listening to a song or the news, seeing or hearing an airplane overhead, reading a story in school, or watching the news about a terrorist attack. A fireman's siren, a jet fighter, a soldier in uniform, a postal letter, or a balloon bursting can trigger sudden and intense feelings without any warning, and often without any conscious connection to their grief and loss issue.
Common characteristics of grieving children. Children in the 21st century experience grief-related issues involving safety and protection that many adults may not have had as children. Whether children ever really enjoyed the protection of the adults in their lives is a debatable question, but the perception of that safety seems to have existed in previous generations. Although grief-related issues have always existed through time, today's children are exposed to an extraordinary visual and auditory barrage of input. The news, the World Wide Web, music, and videos are constantly bombarding children with sounds and images of school shootings, killings, violence, and abuse. Children are left with feelings of vulnerability and defenselessness. Either by real circumstances or vicariously through media reports, young people are inundated with issues such as murder, suicide, AIDS, abuse, violence, terrorism, and bullying that often hinder their natural grief processes. This disruption is an overlay for other interactive components that may affect a child's grief process.
Three categories of interactive components can be examined in assessing the grieving child (Webb, 2002):
The flowing and overlapping of these components create a complex world for the grieving child. Individual factors include cognitive and developmental age; personality components; past coping mechanisms in the home, school, and community environments; medical history; and past experience with death. Death-related factors involve the type of death, contact with the deceased such as being present at death, viewing the dead body, attending funerals and gravesite, expressions of "goodbye," and grief reactions. The third group of variables concerns the child's support system including grief reactions of the nuclear family and extended family; school, peer, and religious recognition and support of the grief process; and cultural affiliation including typical beliefs about death and the extent of a child's inclusion. Other factors related to a death that may increase complications for the grief process include suddenness and lack of anticipation, violence, mutilation, and destruction, preventability and/or randomness, multiple death, and personal encounter of the mourner such as a threat or shocking confrontation.
As noted by Webb (2002), "although virtually any death may be perceived by the mourner as personally traumatic because of the internal subjective feeling involved ... circumstances that are objectively traumatic are associated with five factors known to increase complications for mourners" (p. 368). Learning to recognize the signs of grieving and traumatized children is essential to normalizing their experience of grief and trauma. A mental health counselor needs to be educated in these common signs in order to reinforce for bereaved children, families, and educators that these thoughts, feelings, and actions are natural consequences in the child's grief process. This reassurance helps to reduce anxiety and fear.
Children may experience the following physical, emotional, cognitive, and behavioral symptoms common in the grieving process: The child (a) continually re-tells events about his or her loved one and their death; (b) feels the loved one is present in some way and speaks of him or her in the present tense; (c) dreams about the loved one and longs to be with him or her; (d) experiences nightmares and sleeplessness; (e) cannot concentrate on schoolwork, becomes disorganized, and/or cannot complete homework; (f) finds it difficult to follow directions or becomes overly talkative; (g) appears at times to feel nothing; (h) is pre-occupied with death and worries excessively about health issues; (i) is afraid to be left alone; (j) often cries at unexpected times; (k) wets the bed or loses his or her appetite; (l) shows regressive behaviors (e.g., is clingy or babyish); (m) idealizes or imitates the loved one and assumes his or her mannerisms; (n) creates his or her own spiritual belief system; (o) becomes a class bully or a class clown; (p) shows reckless physical action; (q) has headaches and stomach aches; and (r) rejects old friends, withdraws, or acts out.
Complications in children's grief.In addition, children's grief can be complicated, and common signs include withdrawal, sleep disorders, anxiety, difficulty in concentration, and regression. The common signs associated with children's bereavement may become heightened by their intensity, frequency, and duration. The term disenfranchised grief is used by Doka (1989) to refer to losses that cannot be openly acknowledged, socially sanctioned, or publicly mourned. Five categories of situations may create complications for the bereaved child (adapted with permission from Goldman, 2001).
These categories are:
They explain circumstances that can create complications leading to obstructions in the child's grief process. Awareness of the commonality of feelings and thoughts surrounding these situations can aid the mental health counselor in normalizing what may seem so unfamiliar for the children.
Sudden or traumatic death can include murder, suicide, a fatal accident, or sudden fatal illness. With a sudden or traumatic death, an unstable environment is immediately created in the child's home. Children feel confusion over these kinds of death. A desire for revenge often is experienced after a murder or fatal accident. Rage or guilt, or both, emerge against the person who has committed suicide. A terror of violence and death unfolds, and the child feels shock and disbelief that suddenly this death has occurred.
Social stigma and shame frequently accompany deaths related to AIDS, suicide, homicide, terrorist attacks, or school shootings. Children as well as adults often feel too embarrassed to speak of these issues. They remain silent out of fear of being ridiculed or ostracized. These suppressed feelings get projected outward in the form of rage or inward in the form of self-hatred. Often times these children feel lonely and isolated. They cannot grieve normally because they have not separated the loss of the deceased from the way the deceased died.
Multiple losses can produce a deep fear of abandonment and self-doubt in children. The death of a single parent without a partner is a good example of a multiple loss. When the only parent of a child dies, the child can be forced to move from his or her home, the rest of his or her family and friends, the school, and the community. The child is shocked at this sudden and complete change of lifestyle and surroundings, and may withdraw or become terrified of future abandonment. Nightmares and/or bed-wetting could appear.
The past relationship to the deceased can greatly impact the grieving child. When a child has been abused, neglected, or abandoned by a loved one, there are often ambivalent feelings when the loved one's death occurs. A 5-year-old girl whose alcoholic father sexually abused her may feel great conflict when that parent dies. Part of her may feel relieved, even glad, to be rid of the abuse yet ashamed to say those feelings out loud. She may carry the secret of the abuse and become locked into that memory and be unable to grieve. Children often feel guilt, fear, abandoned, or depressed if grief for a loved one is complicated by an unresolved past relationship.
The grief process of the surviving parent or caretaker greatly affects children. If the surviving parent is not able to mourn, there is no role model for the child. A closed environment stops the grief process. Many times the surviving parent finds it too difficult to watch his or her child grieve. The parent may be unable to grieve him or herself or may be unwilling to recognize the child's pain. Feelings become denied and the expression of these feelings is withheld. The surviving parent may well become an absentee parent because of his or her own overwhelming grief, producing more feelings of abandonment and isolation in the child. Children often fear something will happen to this parent or to himself or herself and, as a result, become overprotective of the parent and other loved ones (Goldman, 2001).- Goldman, Linda; Counseling with children in contemporary society; Journal of Mental Health Counseling; Apr 2004; Vol. 26; Issue 2.
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