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Therapy for Children's Grief
Bereavement in childhood is not expressed in the same manner common to adults and is related to the child’s developmental state; but that does not mean that it is any less painful and potentially pathological (Black, 1998; Shultz, 1999). By age five, the child can appreciate that death is permanent (Black, 1998). Grief and bereavement have immediate and long-lasting consequences (Black, 1996; Dowdney et al., 1999; Luecken, 2000). Child and adolescent bereavement often results in depression, anxiety, and behavioral disturbances (Christ, Siegel, & Christ, 2002; Dowdney, 2000; Sanchez, Fristad, Weller, Weller, & Moye, 1994; E. Weller, Weller, Fristad, & Bowes, 1990; R. Weller, Weller, Fristad, & Bowes 1991). In one study, 37% of children suffered major depressive disorder one year after bereavement (R. Weller et al., 1991). In bereaved children, childhood psychiatric disorders are increased five-fold when compared to the general population (Rutter, 1966). The expression of grief has been correlated to improved functional status (Kranzler, Shaffer, Wasserman, & Davies, 1990).
Further, unresolved childhood grief and perception of vulnerability to loss result in impaired adult relationships and increased adult psychopathology (Edmans & Marcellino-Boisvert, 2002; Mireault & Bond, 1992). Early parental loss through death or permanent separation is statistically associated with vulnerability to major adult psychiatric illnesses (Agid et al., 1999). An anthropologic study suggests that the loss of the maternal grandmother is associated with decreased lifespan of the child (Jamison, Cornell, Jamison, & Nakazato, 2002). This study is of increasing significance in our modern society wherein both parents work and the role of caregiver often reverts to the grandparents (Fuller-Thomson & Minkler, 2001).
Though bereavement in childhood is critical and its role in later psychopathology quite significant, there is still relatively limited research and that which has been studied is most often related to death of parent or sibling (Agid et al., 1999; Black, 1998; Cerel, Fristad, Weller, & Weller, 1999; Christ et al., 2002; Dowdney, 2000; Dowdney et al., 1999; Kranzler et al., 1990; Luecken, 2000; Mireault & Bond, 1992; Sanchez et al., 1994; Thompson et al., 1998; Tweed, Schoenbach, George, & Blazer, 1989; E. Weller et al., 1990; R. Weller et al., 1991). There is minimal research associated with childhood bereavement and the death of grandparents, though one study supports lower functioning of adolescents admitted to a psychiatric facility when there is grandparent death during infancy or when the patient’s mother severely reacted to the grandparent’s death (Yates et al., 1989). A body of literature addresses multiple catastrophic losses and traumatic events in childhood and adolescence; however, no literature addresses the multiple losses that can occur within an aging family and how the bereaved child should best cope with such (Bolton, O’Ryan, Udwin, Boyle, & Yule, 2000; Laor et al., 2002; Papageorgiou et al., 2000; Pfefferbaum et al., 2000; Winje & Ulvik, 1998).
Specifically, multiple losses within short periods of time make one question life and can exponentially influence one’s coping skills. But what are the effects on a child and what should be done when the next loss occurs? In this unusual case, a 7-year-old boy bereaved the loss of five significant relatives within 18 months in the context of being born to older parents.
Though the grandfather was in a non-responsive state, the child was able to verbalize many feelings and thoughts not only about Papa Jerry but also about Bubby Becky. Sadness was an intermittent feeling expressed as well as caring for his father. At one point, he told his mother, ‘‘This doesn’t look too good; Daddy may soon be an orphan.’’ When the grandfather improved, and was able to talk, brightness was noted in the child—he playfully talked to his now communicative grandfather and showed relief regarding his father’s plight. After a brief time in a rehabilitation facility, the grandfather regressed, required hospitalization, had a respiratory arrest with re-intubation, and was found to have a dissected thoracic aortic aneurysm. At this juncture, the child desired to learn medically what had occurred and the parents utilized the mayoclinic.com website to review with the child aneurysms. He appeared relieved to understand the illness process and it made it possible for him to understand that his paternal grandfather would die shortly. At the eulogy, the child again spoke and eloquently read from his hand written card with his penciled rose:
‘‘Too many petals and thorns have fallen from the family tree.’’ And at the graveside funeral, he requested and shoveled earth onto the coffin.
To the parents, this was a difficult death, for they were both older than the deceased and suddenly realized that the child would question his vulnerability. In the process of packing for a trip for the memorial service, the child began to revisit issues involving his paternal grandparents. He focused on wanting to return to Roosevelt Beach where the seaweed fights were as remembrance:
‘‘We could go there in the future. The beach will always be our place to remember both Bubby Becky and Papa Jerry.’’ Just before the trip, the family learned of the fifth loss—Uncle Richard’s mother-in-law, who had no noted illnesses, had died from a burst cerebral aneurysm (5-31-03). As such, the memorial service had the burden of two deaths. This child was the only cousin= niece=nephew to actually speak at the uncle’s eulogy where over 200 persons were in attendance. He commented ‘‘Richard I did not know you well or see you often, but I hope you are happy with your mom. Richard you are my uncle and will be my uncle forever.’’
Aftermath to the Five Deaths
a) ‘‘I can visualize the blood stopping in the heart.’’
And this suddenness appeared to be the key: he was able to accept the first four deaths due to age and illness, but when the fifth died suddenly he went into thoughts regarding suddenness of death and whether it would affect him=his parents=others and even what career he should aspire to in order to prevent such death. Then he had dreams wherein everyone in the family died from a CVA or MI and then they were killed a second and a third time and finally they went into a black heaven (abyss) in which they were truly dead. He continued to relive different aspects of each death and finally asked when Uncle Richard developed diabetes; when told 8, he was frightened.
The parents continued to encourage his verbalization and writings and discussed emotions and illnesses openly while emphasizing his health and the health of his parents. With time, the child was not overtly sad and instead he focused on positive activities with his parents and positive memories of the deceased. Though the child did not make as many overt statements regarding death, grief, and loss as he had before, his writings continued and were very significant.
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