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Death, Dying and the Child 2007 Psyc 456 Dusana Rybarova.

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Presentation on theme: "Death, Dying and the Child 2007 Psyc 456 Dusana Rybarova."— Presentation transcript:

1 Death, Dying and the Child 2007 Psyc 456 Dusana Rybarova

2 Child’s reactions to loss of a parent Elisabeth Kubler-Ross: On Children and Death 0-6 months: 0-6 months: –Displays distress from loss by changing sleeping and eating habits –Reacts to grief reactions of others –Needs continuous loving care 6 months to 2 years 6 months to 2 years –Doesn’t understand the permanence of the loss, will ask for the missing parent –May become angry because parent doesn’t come back, disinterest in play and food –Clinging to caregivers and refusal to let them out of sight –Constant loving care is the key

3 Child’s reactions to loss of a parent Elisabeth Kubler-Ross: On Children and Death 3 to 5 years 3 to 5 years –Asks questions concerning absence of the parent –Anger reaction to unfulfilled wish of parent’s return –Magical thinking, thoughts about life in the cemetery –Clinging to favorite toys –Importance of talking to the child and giving her/him loving attention 5-9 years 5-9 years –Beginnings of understanding of the finality of death –Grieving manifest in changes in behavior, school performance, anger reactions –Important to have trusting relationship which allows the child to talk about their grief and distress –At age 9, with maturation of abstract thinking processes, most children have mature understanding of the concept of death

4 How to react Is death like sleeping? Is death like sleeping? –Death is different from sleeping. When a person is dead, his or her body doesn't work anymore. –children who are told that death is like sleeping may develop fears about falling asleep. Why did they die? Why did they die? –the person's body couldn't fight the sickness any more. It stopped working. –Explain that when most people get hurt they can get better and live a long, long time. Will you die? Will I die? Will you die? Will I die? –Let your child know that most people live for a very long time. –Children also need to know who will take care of them if a parent or guardian dies. Did I do or think something bad to cause the death? Did I do or think something bad to cause the death? –Reassure your children that saying and wishing things do not cause a death to happen.

5 How to react Will they come back? Will they come back? –"Forever" is a hard concept for young children to understand. –Young children may need to be told several times that the person won't be back ever. Is she cold? What will he eat? Is she cold? What will he eat? –Young children may think the dead body still has feelings and walks and talks under the ground. –explain that the body doesn't work anymore. It can't breathe, walk, talk or eat anymore. Why did God let this happen? Why did God let this happen? –Answer questions related to God and your faith according to your own beliefs. –It is best to avoid suggesting God "took" someone to be with him, or that "only the good die young". –Some children may fear that God will take them away too. They may try to be "bad" so that they won't die, also.

6 Child Suicide Increase in suicide in children between 5 and 14 years of age Increase in suicide in children between 5 and 14 years of age Child suicide is influenced by immature understanding of death: Child suicide is influenced by immature understanding of death: –Death understood as a transient and reversible state –Death as a vehicle to a happy reunion with the deceased or as a gateway to a happier situation –Inability to understand multiple dimensions of a situation

7 Erik Erikson’s model of life-span development Stage 1: Trust vs Mistrust Stage 1: Trust vs Mistrust –Infancy –Counts on caretakers to meet her/his basic physiological, social and belonging needs –Based on that experience develops understanding of the world as a predictable place –Long-term unpredictable separation may lead to anxious, emotionally defensive reactions Stage 2: Autonomy vs Shame Stage 2: Autonomy vs Shame –Toddler –Learns what he/she can control (preference of food, preference of toys, excretory functions) –Belittling a child’s efforts can lead to feelings of shame, self- doubt and a lasting sense of inferiority

8 Erik Erikson’s model of life-span development Stage 3: Initiative vs Guilt Stage 3: Initiative vs Guilt –Early childhood 3-6 years –Explores environment, initiates new activities, takes on new challenges –Lack of encouragement may lead to self-negation, guilt, resentment and unworthiness Stage 4: Industry vs Inferiority Stage 4: Industry vs Inferiority –6 years to adolescence –Learns to function in adult-like world, compares itself to the standard or others –If the child does not learn strategies to overcome life’s challenges and crises, it can in most extreme cases result in self-destructive, suicidal behavior

9 Humanistic perspective Each human being is unique and child’s reaction to loss depends on their unique personal experience, which goes beyond the child/parent bond and stages of cognitive development Each human being is unique and child’s reaction to loss depends on their unique personal experience, which goes beyond the child/parent bond and stages of cognitive development To understand child’s grief their individual experience, environmental, familial and cultural background needs to be taken into account To understand child’s grief their individual experience, environmental, familial and cultural background needs to be taken into account Questioning of stage theories of development as a key to understanding children’s concepts of death and grief reactions Questioning of stage theories of development as a key to understanding children’s concepts of death and grief reactions

10 The Dying Child Terminally ill children as young as 3 years old come to know that they are dying, and that death is a final and irreversible process Terminally ill children as young as 3 years old come to know that they are dying, and that death is a final and irreversible process _Discussing_Death_with_a_Dying_Child.asp _Discussing_Death_with_a_Dying_Child.asp _Discussing_Death_with_a_Dying_Child.asp _Discussing_Death_with_a_Dying_Child.asp Children may not be able to talk about death but express their understanding of their approaching death in their behavior Children may not be able to talk about death but express their understanding of their approaching death in their behavior –Fear of wasting time, wanting to have things done right away –Dislike of talking about the future –Absorption with death and disease –Setting up a distance from others but acts of anger and silence

11 The Dying Child le.html le.html le.html le.html Stages: Stages: –Initial awareness of the seriousness of the illness –Learning names of various drugs and medical procedures, perceives that he/she is seriously ill but will get better –Learns the purpose of various medical procedures and perceives that she is always ill but will get better –After series of relapses he perceives that he wil never get better –After numerous relapses and remissions understands that he/she is dying (often associated with leaning about death of a peer with the same disease)

12 Feelings of a Dying Child Fear and anxiety Fear and anxiety –Separation from parents and other family members –Increasing anxiety of medical procedures –Increased anxiety because of feelings of fear and anxiety in their family members Anger Anger –Loss of self-control and independence –Often results in developmental regress to an emotional level at which they are no loner independent –Some children overcompensate by refusal of help from family and hospital personnel Sadness Sadness –Grieving loss of what they had before the illness (decline in contact with friends, absence from social and other activities, pain, discomfort, decreasing mobility, alterations in body image etc.) Loneliness and Isolation Loneliness and Isolation –Because of mutual presence of the approaching death, there may be no opportunity for parents and the dying child to truly share their concerns and fears and provide comfort, security, and reassurance –Children’s feelings about death sometimes become masked and repressed

13 Feelings of a dying child Often marked by mutual pretense of the approaching death Often marked by mutual pretense of the approaching death Children may want to maintain the pretense that they are feeling well because they are afraid of being abandoned or rejected Children may want to maintain the pretense that they are feeling well because they are afraid of being abandoned or rejected ‘ To let children talk about death, about their fears and feelings, their hopes and despairs, their certainties and uncertainties, their love, and hate, means we are allowing them to talk about life, their life, and we are providing them with the only possible help: the presence of another human being until the end.’ ‘ To let children talk about death, about their fears and feelings, their hopes and despairs, their certainties and uncertainties, their love, and hate, means we are allowing them to talk about life, their life, and we are providing them with the only possible help: the presence of another human being until the end.’ Spiritual needs Spiritual needs –Prominent in the lives of dying children –A positive image of what lies beyond death –Reassurance that they will be remembered Individual differences Individual differences –Some children are resilient and playful even when their life is ending

14 Three stages of bereavement in the young child dealing with death of a parent Protest Protest –Anger and fear aimed at reattachment to the lost parent Despair Despair –Sadness, distance, unresponsiveness –May result in psychosomatic symptoms (headaches, enuresis,…) or psychological problems (school phobia, depression, poor school performance) –Slowly processing the loss Detachment Detachment –Moves from depression to increased activity and openness to new relationships

15 Reactions and Grief Strategies Regression to an earlier developmental stage Regression to an earlier developmental stage –If denied the opportunity to openly grieve a lost parent, the child is likely to remain frozen in the regression –With time and nurturance the regression will subside Hyperactivity Hyperactivity –Increased activity to get attention Emotional outbursts Emotional outbursts –Angry outbursts and irritability as symptoms of grief Overprotectiveness of the surviving parent Overprotectiveness of the surviving parent –Preoccupation with the remaining parent’s potential death Constructing the deceased parent Constructing the deceased parent –Locating, experiencing and reaching out to the deceased parent, waking memories of the parent, cherishing objects shared by the child and the dead parent

16 The Death of a Sibling Bereaved siblings show significantly higher levels of behavior problems and significantly lower social competence than normal children throughout the bereavement period Bereaved siblings show significantly higher levels of behavior problems and significantly lower social competence than normal children throughout the bereavement period Siblings can tolerate and accept less parental attention and more anxiety if they know what is happening with the dying sibling Siblings can tolerate and accept less parental attention and more anxiety if they know what is happening with the dying sibling The anxiety level of a children informed about terminal illness and loss was found to be significantly lower than that of uninformed children The anxiety level of a children informed about terminal illness and loss was found to be significantly lower than that of uninformed children Bereaved children need explanations, comfort, and support Bereaved children need explanations, comfort, and support Pretense and avoidance can be frightening to anyone in a stressful and painful setting, especially a child Pretense and avoidance can be frightening to anyone in a stressful and painful setting, especially a child If children are involved in grieving of the family, it helps them to learn coping strategies they can rely on in dealing with future losses If children are involved in grieving of the family, it helps them to learn coping strategies they can rely on in dealing with future losses

17 When a Pet Dies For many children loss of a pet is their first experience with death For many children loss of a pet is their first experience with death Reactions to death of a pet across ages: Reactions to death of a pet across ages: –Preschool children appear to miss the animal more as a playmate –School-age children express profound grief over the death of a pet, but usually for a short-time and adapt quickly to the change –Older children and adolescents tend to have the most profound experiences with the loss of a pet, possibly because of their adult understanding of the death as final, permanent, inevitable, and irrevocable Through this experience children can learn that ‘death is a natural part of the life process, that death is permanent and painful, that the grieving process itself is tolerable and doesn’t last forever, and that feelings of guilt, sadness, and anger following death are common and can be overcome.’ (Levinson, 1972) Through this experience children can learn that ‘death is a natural part of the life process, that death is permanent and painful, that the grieving process itself is tolerable and doesn’t last forever, and that feelings of guilt, sadness, and anger following death are common and can be overcome.’ (Levinson, 1972)


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