Grief Patterns In Children Essay, Research Paper

A simple child

That lightly draws its breath

And feels its life in every limb

What should it know of death.

–Henry Wordsworth

This question has been posed by many philosophers, religious leaders and psychologists for centuries, yet has been a potent taboo in society even today. As the field of psychology is gaining ground and knowledge in how behaviors affect the way in which we interact with others, we are discovering new ways to approach and view the mental processes of a human and apply them to how a person grieves that loss. But while oft times those assumptions, hypothesis, and theories are made by adults for adults, the child is a more difficult subject in which to study since it has not achieved its mature mental capabilities. For the adult, a full and eventful life is the predecessor of a grasp of what life and death actually entail, whereas for the child a pure and incomprehensible approach is taken when trying to understand and rationalize its loss. These differences cause much pain and suffering for both adults and children when one does not understand what each is going through and needs, especially those of the child.

It is often mistaken that bereavement, grief, and mourning are all used synonymously, when they are all in fact quite different terms, which are essential to understanding what relates to a loss proceeding a death. Bereavement alludes to the stress that the person who has experienced the loss is feeling, but not necessarily defining the stress’ nature. Grief is the actual process that follows in stages which may occur at different times ensuing the death and loss. According to Tom Golden, LCSW, "grief is related to desire. Whether the desire is large or small, if it is not met, (one) will probably have grief." (Tom Golden, Crisis, Grief, & Healing) Mourning, according to Sigmund Freud, is "the mental work following the loss of a love object through death." (Fuhrman, 1974, p 34, quoting S. Freud, 1915/1957) It not only concerns itself with the present loss but also with the future possibility of relationships. But when a person experiences the loss of a parent through death, they are forever shaped and mettled.

Although it has been theorized and debated over whether a child mourns or is even capable of mourning, the affirmations on the cases’ part have been very well supported. In order to understand the different and unique dimensions of grief, the child’s needs, and what is involved in grieving and coping with the loss, one must cognize the child’s development of the mind and at what stages it is able to conceive abstract and concrete ideas.

In order to utilize conceptual understanding of death, Piaget’s developmental stages are applicable to how a child views the absence due to death. Piaget dealt mostly with qualitative changes in the mind and explained changes in the physical world, which also makes him a suitable model to follow since the loss is physical. Most humans, at some point in their lives, come to recognize that death is constant, inescapable, and omnipresent, which is naturally evolved by their ability to think rationally and maturely; some learn this harsh fact at an unfortunately early age. There are many stages of the development of a child from birth which deal with needs and the methods by which new ideas and information are collected and assimilated to the knowledge they already know. This also provides a future backdrop for future situations and possibly survival.

In Piaget’s first stage of development, the sensorimotor period, which occurs from birth until the age of two, deals with infants discovering the world through their five senses; the infants learn also through applying their motor skills and polishing them. They can also only distinguish things that are present–which are able to be seen, touched, or heard–and ends when the infant can create mental representations in their minds of those objects.

In his second stage, the preparation stage, which extends to age seven, the child cannot differentiate between thoughts and conduct, which in turn confuses the child and can make the child feel to blame for the death. During this time, Nancy Boyd Webb says that "the child’s thinking is concrete (literal) and sometimes distorts reality to conform to his/her idiosyncratic understanding, despite logical contradictions. Piaget refers this type of thinking as ‘egocentric’ since the child believes that everyone sees the worlds as he/she sees it." (1993, p. 5) In turn, the child cannot understand the finality and irrevocability of death. They know only about things they have truly touched; they believe that inanimate objects possess life and other human qualities and that an object is the same even in spite of its change in appearance.

The following stage is titled the operational period, which last until age eleven, and involves the use of concrete operational thought. During this stage they do not concentrate upon the countenance of objects but are now able to form the images in their minds and manipulate that image mentally. Their logic is still influenced only by articles that are tangible, and not so much by possibilities.

When a child reaches anywhere from ages nine to twelve, the start to border on Piaget’s formal operational stage, which is constituted by "a succession of three great periods. Each of these extends the preceding period, reconstructs it on a new level, and later surpasses it to an ever greater degree." (Piaget & Inhelder, 1969, p. 152) This stage truly starts around the age of eleven or twelve, when the child is capable of multiple mental tasks and abstract ideas. Most developmental authorities disagree with the rigidity of levels corresponding to age, saying that around age nine or ten the child achieves a realistic perception of death’s finality and invariability. Wolfelt supposes that "it attests to the complexity of death itself–connecting both

‘concrete’ elements–that is, a body that no longer functions (comprehensible to the 9- and 10-year-old)–and the ‘abstract’–that is, a notion of spirituality and life after death (understood by children older than 10)." R. Lonetto, from his 1980 study of children’s grief reflected by their drawings, also disagrees with Piaget by saying that "children from nine to twelve years old seem capable not only of perceiving death as biological, universal, and inevitable, but of the feelings generated by this quality. This complex recognition pattern associated with death is joined by an emerging belief in the morality of the self, but for those children death is far off in the future and remains in the domain of the aged." (Lonetto, 1980, p. 157) They are also capable of linking any element or assertion to another element or assertion and are capable of managing analogies. Another important characteristic of this phase is that the child is able to reflect on their new mental abilities, especially thinking.

How a child is going to respond to his or her loss is very much relative to the child’s stage of development. Many other researchers in the specialization of child grief and bereavement have done research dealing specifically with the child’s perception and, in turn, reactions in the loss of a parent. One of these people is Maria Nagy, and although some of her work did reflect Piaget’s, most of it dealt with the child’s perception of death, identified by three distinct stages.

In her first stage, Nagy found that the children ages of three to five demonstrate the denial that the death has occurred or that it is the final event. The children also believe that they are capable of bringing the parent back and that their condition is only temporary. Even after seeing their deceased parent in the casket at the funeral or wake, the child may still ask when he or she is going to come home.

In the second stage, the children from ages five to nine, they begin to understand the physical existence of death, yet take it to an extreme and personify death and tend to dismiss the fact that it is a potentiality.

In Nagy’s final stage, which occurs around the ages of ten or eleven, the children begin to recognize the attributes of death (irreversible, biological, and universal), and that death is possible for everyone including himself or herself. They became much more aware of social connections and other matters implied by death.

The only reproach to Nagy’s study was that it was conducted in the late 1940’s in the country of Hungry, which was still attempting to revive from World War II. The subjects for her experiments most likely had all lost someone close to them and had witnessed the war–bombs, blood, and death–and may also explain why they had a partiality to personifying death. This phenomenon may also support the idea that the beliefs of the culture and experiences form the children’s concepts of death.

Another investigator of children’s understanding of death was S. Anthony, who too had three stages of children’s perceptions of death. She resolved that children ages three to five are unclear about the word "dead" yet still are interested in it in spite of their conception is limited of inaccurate. In the second stages, ages six to eight, all the children in her study had an awareness of what death inhered. Corresponding to Nagy’s final stage the children rationalized death and were able to put in the biological perspective.

Along with what the child is actually perceiving, they also have needs which must be met: physical, emotional, psychological, and social. These are all important to the child even though at some point in the child’s development one of these conditions may seem more important than another, but at some degree must be attained. For these needs to be rationalized, another aspect of developmental psychology must be examined. Erik Erikson’s stages of psychological development presents issues which reflect developmentally-appropriate needs.

In the first year of the child’s life, the infant learns their first lessons about the world, which are that its basic needs will ultimately be met. The key is to form a primary trust or mistrust, which is especially the case of the mother, which will later reflect the child’s view of the world.

During the end of the first year the child will have ideally formed a strong bond with their parents, and will move on to assay its autonomy yet still have a healthy relationship with its parents. This stage strives to make the children feel comfortable about doing things independently or whether they are uneasy with such freedoms.

Erikson’s third stage occupies the third to fifth year styles the child to elaborate upon their own actions and to appreciate their achievements. They begin to test their will, begin their own exploits to learn more of their environment, and also to acknowledge their independence.

About the age of six up to puberty, the child develops a sense of perseverance and is very anxious about learning–ideal for teaching the basics as in elementary school. The children’s curiosity is prime during this stage and if encouraged the child will not lose interest and will exert the energy required to do almost any task presented.

After puberty, a child goes through the adolescence stage, which constitutes a formation of its own, personal, unique identities. They also see themselves as people formed by environment and its contents (i.e.–education, experiences, other people, etc.). If this stage is not dealt with, a child will not have a clear view about what they want to acquire of themselves during their life.

After a youth has found his or her identity, he or she potentially become able to involve themselves with another person and are able to commit to their partner. Assuming the individual does not form such a view they tend to believe that they are alone and feel detached from the world.

When a child does not resolve its conflicts in each stage they tend to elucidate the qualities of that stage and cannot effectively resolve the proceeding stage. If a child’s needs are not met, whether they are social, psychological, physical, or emotional, they are disposed to exhibit the attributes of the stage they were at.

A major difference in humans is that of the perception and reactions due to differences in gender. This may not be the case with each developmental age group, but may be more applicable during later stages of childhood and adolescence. Women are apt to look at things in details, whereas the men contrast by looking at "the big picture." The men also use his rationalization and logic when settling an issue or acting on one; the women deal with their feelings and their intuition before acting. So when a man deals with an issue it is deal with internally, and for the woman it is dealing with issues externally.

Another major player in the child’s recognition of death has to do with the society, culture, and religion the child grew up in. There are many aspects that compose this element, and they deal mostly with how they interact with the child before, during, and after the death and loss of a parent. A major part is the structure of the child’s family, be it a nuclear family, extended family, or any other family setting. School and peers also acts on the child’s perception, and how the playmates and schoolmates handle the issue of having a classmate’s parent die. Religious affiliation (specifically how actively the family practices their faith and what its ideology is) can mean a great deal to the child. With the role of culture, the society’s mores are about death, how it should be handled, and how inclusive the child should be all have bearing on how the child views death.

The reason of death also effects a child, including how that child was interacted with the death process. Rando points to the fact that children are naturally curious about the cause of death and "the death surround," or those specific causes, are taken into account by the child when assessing their loss. (1988/1991, p 52)

Sudden deaths promote a tendency toward rejection that the death occurred. Since most children are anxious regarding their personal vulnerability, this cause is grounds for an raised concern on the child’s part of their own susceptibility to death.

Children are also very sensitive with regard to pain. Equivalent to the child’s viewpoint held on vulnerability, Webb also believes that "elements of violence and trauma associated with the death also raise anxiety levels and may interfere with the grief process." (1993, p. 34) Eth and Pynoos also caution that "children are particularly vulnerable to the additive demands of trauma mastery and grief work. The obligatory efforts at relieving traumatic anxiety can complicate the mourning process, and greatly increase the likelihood of a pathological grief response." (1985, p. 179)

From a social standpoint, the death holding a stigma that a culture is not inclined to (i.e.–suicide, AIDS, drug overdose, murder or homicide), the losses are labeled "disenfranchised grief" by Doka, and "(refers) to losses that cannot be openly acknowledged, socially sanctioned, or publicly mourned." These factors, intermixed with feelings of infamy and the natural feelings during grief, confound in the survivor and create feelings of guilt and animosity.

Since the needs and desires of a child have either been changed or not met, this causes grief within the child, be it an infant or a teenager. S. Freud, D. W. Krueger, H. Nagera, J. Robertson, and J. Bowlby span over forty years of exploration into the mourning capabilities and capacities in children. Although they all have different views on when they child can actually comprehend the loss, they also have different stages during which the child realizes its loss.

Bowlby, Robertson, and Freud had strong attestation that the infant, in its own form, experienced grief. Robertson conducted a study on eighteen- to twenty-four- month-olds that had sustained the detachment of their mothers and concluded that:

If a child is taken from (its) mother’s care at this age, when (it) is so possessively and passionately attached to her, it is indeed as if (its) world has been shattered. (Its) intense need of her is unsatisfied, and the frustration and longing may send (it) frantic with grief. It takes and exercise of imagination to sense the intensity of this distress. (It) is overwhelmed as any adult who has lost a beloved person by death. To the child, of two with (its) lack of understanding and complete inability to tolerate frustration, it is really as if (its) mother had died. (It) does not know death, but only absence; and if the only person who can satisfy (its) imperative need is absent, she might as well be dead. (1953)

Freud also argued that the child’s facial expressions were evidence of distress, that the child "cannot yet distinguish between temporary absence and permanent loss. As soon as it loses sight of its mother, it behaves as if it were never going to see her again." (1926/1959, p. 169) Relying on Piaget and his views on object constancy, the child "(lacks)… understanding that the mother (continues) to exist when she goes away." (Webb, 1993, p. 9)

Others view Bowlby’s stages of protest, despair, and detachment as fantastical and inaccurate because these responses, according to Webb, are not mourning: "the young child understands neither the finality of the loss nor its significance in his/her life. Thus, feelings of sadness, rage, and longing following the loss of a significant person may qualify as grief reactions, but without mature understanding of the finality and meaning of that loss, cannot accurately be termed as ‘mourning’ in (her) view." (1993,

p. 9)

Once the child grasps that the mother is an independent person and that it can maintain the constancy of its mother, then is when A. Freud (1960) and E. Fuhrman believe the child can acknowledge the loss of its mother.

When the child can grasp that loss, there are many phenomenon which occur, Dr. Alan Wohlfelt has designated thirteen dimensions into a "manageable framework," displaying the symptoms most commonly shown by children. (1983, p 31) When a child experiences a loss, the change "can and often does produce major emotional, physical, and behavioral changes." (p. 32)

One of the initial responses is an impression of shock, which can be denial, disbelief, and numbness, which usually lasts the duration of six to eight weeks following the death. These symptoms may reappear upon any significant event relating to that death, such as an anniversary, holidays, birthdays, or any other milestone. Wohlfelt has noted that "when reality seeps through, in this sense of disbelief, children may well do some ‘catch-up grieving’ as thoughts and feelings surface that previously have been blocked from full consciousness." (p. 32)

One of the most troublesome dimensions is the child’s lack of feelings or displays of emotions. This is closely alike to the sense of denial, the child’s attempt to insulate themselves in the only means they know how. On the other end of the spectrum, the child who does not display their emotions is believed, in some cultures, to be "taking things well." This often leaves the child stuck between the questions posed by the adults who can fathom the loss and what the child is in fact feeling.

The physiological changes occur following word of the death, and are exemplified by Wohlfelt’s examples:

otiredness, lack of energy;

odifficulty in sleeping of on other occasions prolonged sleeping;

olack of appetite or excessive appetite;

otightness in throat;

oshortness of breath;

ogeneral nervousness, trembling;

oheadaches;

ostomach pains;

oloss of muscular strength; and

oskin rashes

(Figure 3.2, p. 34) Children also manifest "sick roles" by identifying with the physical symptoms that the loved one died of. This occurs when the child does not receive "consent" to have another, healthier outlet for the expression of their feelings.

Children also frequently incline to return to "the sense of protection and security they have experienced at earlier points in their life. In responding to the sense of loss experienced, normally children will want to return to an earlier developmental level. Unfortunately, our society often perceives regressive behaviors as a total lack of self-control and discourages or punishes both adults and children for displaying this type of behavior." (p. 35) If this child is encouraged to grieve in a healthy and appropriate way, the conduct is typically temporary.

The oxymoron of regressive behaviors is what Wohlfelt designates as the "Big Man" or "Big Woman" syndrome. This is illustrated by the child’s endeavor to develop

into the missing parent-figure. The child could be attempting to keep the parent alive or to maintain hope that was existent at some point during grief.

A sudden, unpredictable feature is the "heightened sense of disorganization and panic." (p. 39) Feelings and ideas will seem overwhelming, and the length and continuation of their emotions becomes overpowering. During this phase the child is going to experience many of the same traits that are common during physiological changes, along with susceptibility to showing responses to their strong emotions.

Explosive emotions are also common during this stage and are also very upsetting to the parents because the parents are uncertain on how to handle and respond to the child’s expressions. Explosive emotions may be manifested in several different ways among bereaved children. The child may be angry at the person who died because as the child views the situation: "If Mom had loved me enough, she wouldn’t have died and left me." Then the child may reason: "If Mom doesn’t love me, no one can love me. There must be something about me that makes me unlovable." Or the child may feel that if the person took better care of self the death could have been prevented. Anger and rage may be directed toward anyone: physician, pastor, friends, God and of the world in general. Children may ask themselves if they should ever love anyone again, thinking that another person they love might also "die" (1983, p. 40) As previously mentioned, when the child is coerced to repress their feelings instead of letting them be vented, the adults who repress those feelings are denying the child the means of psychological survival.

Another seemingly inappropriate behavior is expressed by acting out, which is dependent upon the child’s age and developmental stage. "The child may become unusually loud and noisy, have temper outburst, start fights with other children, defy any authority, or simply rebel against everything. Often the child’s grades drop at school, he/she may begin to associate with a different group of friends, and older children may run away from home." They begin to accept anti-social behaviors to keep themselves emotionally distanced from any possibilities of being loved and "abandoned" as their parent had.

When the child realizes that the parent will not return, they become very apprehensive about their surviving parent, whether that parent will "abandon" them also. They begin to become concerned when they see the remaining parent grieving, because their need to feel loved is crucial during this dimension. Their health is also important since they believe any sickness will lead to their own death.

It is seemingly our human tendency to take blame for the death of a loved on and is present even from an early age. Since children have difficulties understanding cause-effect relationships, they believe that their thoughts and actions caused their parents to die. Sometimes this is so since the children may wish for different parents or that an action or bad behaviors made their parents "go away." They conceive self-defeating thoughts and heighten their guilt. They dispose to show good behaviors since they believe that an action they did made their parent "go away," something they can do will "bring them back."

Another concept children struggle with is that of relief, which is very existent after a long struggle before death; the child has "gotten over" much of the grief work and has begun to accept the changes and adapted to them, confusing them that they have completely "let go" of their parent. If a family is not supportive of this and does not anticipate this struggle, the child’s self-esteem is violated in spite of the relief they should feel.

The most difficult of all these dimensions is that of loss, emptiness, and sadness. Even though all these do not take place at once, the latter sets in after the loss has been reckoned and the emptiness has set in. When they accept the reality of death and its finality, they children show such signs as:

oa lack of interest in self and others,

ochange in appetite and sleeping patterns,

oprolonged withdrawal,

onervousness,

oinability to experience pleasure, and

olow self-esteem

(p. 46) "The frequent result is increased anxiety, agitation, and a sense of being emotionally and physically drained" because these signs will exhaust them, leaving them very vulnerable. (p. 47)

One of the last dimensions Wohlfelt mentioned is reconciliation, or that the grief and bereavement have been resolved or recovered from. Even though they seem to "return to ‘normalcy’… everyone–adults and children alike–is changed by grief." (p. 48) The person will recognize that there has been a loss and has created a new life without their parent. But Wohlfelt cautions that "the bereaved child’s reconciliation after a death is a process, not an event." (p. 47)

When expecting a child to demonstrate certain characteristics, it is not uncommon for the parent to be confused since both are on different levels of recognizing the loss and dealing with it. Attempting to understand and sympathize with the child and to help them effectively deal with their emotions and confusion is very helpful, not only for the child but for the parent.

Everyone, at some point in their life, is going to experience a death or have someone close to them experience a death, the key is communication–opening up and being perceptive to the needs of the bereaved. Sometimes the survivors will exemplify attitudes and actions which show independence and strength yet have needs that need to be met.

The everyday changes everyone experiences are and can be very burdensome, but for children, with the uncertainty of their worlds and the people that fill them, it may seem almost impossible to deal with. The significance is in helping the children to deal with their loss at a developmentally appropriate level and to help them "get through" their feelings and to rebuild their lives with the environment in which they’ve been left.