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The 'fainting game' explained in the 'British Journal of School Nursing' Evening Post
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Week 37 - Reactions of Older Children By age five, children begin to understand death and what it means, but because of their immaturity and a lack of coping skills, they work hard to deny the loss. When their feelings do begin to surface, they tend to cry alone in the privacy of their rooms because they may feel that crying is childish. They may also fantasise that their loved one is still alive, but eventually become frustrated as they realize that their fantasies fall far short of the way life was before the death. Grieving adolescents also desire to retreat to childhood where they felt a sense of safety and protection from death and its consequences. However, such reverting creates an inner conflict since they may feel responsible to comfort other family members. Adolescent response to loss is much like an adult's, but typical adolescent problems such as difficulty communicating with adults, heightened emotionality and on-going issues of identity and independence, further complicate their grief process. While teenagers work on the business of growing up, they are likely to put their grieving on hold. However, their pain may be seen through exaggerated adult-like behaviours such as withdrawal, depression and sexual acting out. Three main factors influence a child's grief response: the family relationship patterns before the loss, especially those between the child and deceased; the causes and circumstances of the death - where and what he was told about it; and the extent to which the death changes family life. Next week we will summarize the way in which we, as adults, can help children to deal with the trauma of loss. Week 38 - Helping Children Work through Grief Now that we've briefly covered the grief responses of children of varying ages, here are some points to keep in mind as we help them to resolve their loss. These suggestions are particularly relevant when the death is that of a parent. Observe the child's behaviour and note any apparent lack of concern. Children work hard to deny death, but their outward signs of calm are not likely to truly reflect their inner feelings. Remember that non-verbal behaviour can reveal much about a child's state of mind and stage of grief. Observe behaviour in play to pick up clues. Art is an especially revealing medium through which children convey and work through feelings. Help the young child to remember his parent using pictures, possessions and stories. He can draw on these memories as he works towards accepting the loss of the physical presence. Be aware of any new tasks that children might take on. When they assume the role of 'man of the house' or 'little mother', they may postpone their grief process indefinitely. Remember, too, that as children mature and deal with the issues that normally accompany adolescence and young adulthood, they may need additional information to help them to deal with their earlier loss. Overall, though, children's needs are much like an adult's: validation of their feelings and pain; time; and an environment that gives them ample opportunity to grieve. Next week we will begin dealing with the issues arising from the death of a child. One factor that affects our reaction to grief is our relationship with our lost loved one. When a child dies, we find ourselves dealing with emotions that are unique to the abrupt separation of parent and child. The main element in this type of loss is its unnaturalness: our children are the future generation and, therefore, it seems logical and right that their lives will carry on long after our own have ended. But when this natural order is upset and a child dies out of turn, parents and other family members must deal with the question of why this has happened. The search for answers is often futile as it is with most losses through death; this lack of comprehension complicates and lengthens our grief process and may give rise to what has been called survivor guilt - conscious or subconscious thoughts that make it difficult to accept the fact that our life continues while our child's does not. Another issue with child death is the loss of the parental role that we assume when our children are born. Our task as parents is to love and nurture our offspring, to keep them safe, happy and healthy and to watch over them until they reach maturity and independence. When we are deprived of this role, our sense of loss is compounded and because each of our children is unique and special, the death of one child, even in a large family, can be devastating. Also there are aspects of parenting the remaining children that need to be addressed. The age at which a child dies is often of little relevance to a parent's grief; for even when children have grown and moved away from home, the severing of the parent-child bond represents a major life loss. Others issues are the reactions of friends who are parents themselves and the way in which a child's death impacts on the relationship of the parents as they begin to work their own grief. As with any bereavement situation, the closer we come to understanding our reactions and emotions, the better equipped we are to deal with grief. All of the issues outlined above will be touched upon in the next few weeks. When a child dies, the parents themselves view the child's age as irrelevant and academic. For no matter what the age, they have lost their baby, an integral part of themselves, their dreams and expectations. The fact that a child has died out of turn overrides all other aspects of a parent's grief. However, there are some secondary, age-related issues that also need to be acknowledged. Adolescents tend to have a sense of immortality and often take risks that sometimes result in accidental death. The sudden and often-dramatic circumstances of accidental death increase parental trauma and compound their feelings of loss. Another complicating factor around adolescent death is the normal ambivalence that parents may feel during the tumultuous teen years; a teenager's rebellious behaviour in life may give rise to a parent's mixed emotions that quickly turn into guilt. The pain of parents of adult children is sadly often minimized. Not long ago I was told a tale of two parents who lost their only child aged 43. At the funeral, their outpouring of emotion was judged by some as excessive and inappropriate - as somehow upstaging the grief of the deceased's wife and children. The storyteller's remarks and attitude were based not on malice but a lack of knowledge of the complexities of the grief process. And the bottom line is that a parent is always a parent, no matter what age the child. Societal fear and denial of death often cause us to shy away, albeit sub-consciously, from mourners and especially those who grieve for a child. We want people to return to normal, and when the pain continues unrelenting, we become anxious as we realize that such an incomprehensible tragedy could happen within our own family circle. This gap in social and emotional support has been bridged through the formation of self-help groups such as Parents for Parents and Bereaved Families of Ontario. The founding members of these groups and other such organizations were bereaved parents who found solace through sharing their pain and discussing many aspects of child death, one of which is the subject of next week's column - parenting the remaining children. Week 41 - Parenting the Remaining Children The siblings of a deceased brother or sister need the love, attention and support of their parents. On the one hand, the presence of remaining children can be a great comfort, for while grieving parents continue to fulfil their roles and perform familiar duties, they have a sense of purpose and the motivation to carry on. On the other hand, the remaining children serve as constant reminders of the one who has died; thus, painful memories are triggered. Preoccupation with the deceased child also makes the job of parenting difficult; when we are consumed by sadness and yearn for the physical presence of one we have lost, thoughts of performing everyday, commonplace tasks seem onerous. As well, preoccupation draws on our energy, leaving us feeling emotionally and physically drained. In fact, the grief process as a whole takes an enormous amount of energy. It is normal to idealize - to think only good thoughts of the child we have lost. As we work through our grief, however, we begin to think more realistically. But meanwhile, the remaining children who may be trying hard to fill their parents' void might feel resentful of the idealization of their sibling. This, of course, gives rise to the problem of a child's duality of response - resentment and intense loss of the same person. As parents, we cannot conceive of one of our children dying. But once the unthinkable actually happens, our reality is that it could happen again. And as natural and right as it is that we do everything in our power to protect each of our children, we must be wary of over-protecting them. This impulse often surfaces most noticeably in parents who dwell on the things they did or did not do that they feel contributed to their child's death. This over-responsibility may spill over into the lives of the other children. In two-parent families, it is helpful if the partners share parenting concerns and tasks. However, the death of a child raises relationship issues, as we will examine next week. Week 42 - The Parents' Relationship When a tragedy hits a community, people rally together in the common cause of re-organizing, rebuilding and healing. And when death hits a family, its members, numbed and sad, become a close-knit group who support one another as they come to grips with their loss. Ideally this togetherness continues in the aftermath of the funeral when shock gives way to reality, and each spouse becomes a source of strength for the other. When a child dies, both parents who would normally turn to each other for support simultaneously begin to grieve over this overwhelming loss. However, because individuals are unique and each person's grief process is different, the normal emotions of sadness, anger, depression and guilt may surface in ways that are counter-productive to marital closeness and mutual support. For example, if the child's mother awakens feeling the need to talk, she may tearfully approach her husband hoping for an opportunity to release some of her pain. But at the same time, he may be trying desperately to control his emotions for several reasons. He could be bracing for a particularly challenging day at work; he may have had a hard time on the previous day and needs an emotional reprieve; or he may simply be feeling numb. In any of these cases, his wife may misinterpret his apparent lack of emotion as a sign of callousness. When one of the couple is up and the other down, they are merely lacking synchronicity in their grief experiences. This situation, though common, creates an atmosphere of bewilderment and disappointment, and the spouse who is having a down day may respond emotionally and instinctively, misdirecting anger onto the other. It is important, therefore, that bereaved parents gain some knowledge of the grief process, for when they understand the source of their emotions, they might communicate more effectively and, in so doing, be supportive of one another. Next week we will look at gender differences and roles as they affect a bereaved couple's relationship and grief response. Week 43 - Gender Differences in Grief Work Each of our grief journeys is different, and bereaved parents will be disappointed if they expect their grief responses and stages to be the same. Some differences are a result of roles that they held and lost. A mother who spent her days caring for a child might be painfully aware of the loss of the youngster's physical presence: the touching, cuddling, feeding, talking and listening are gone. A father misses some aspects of his child but at different times, such as after work or perhaps on weekends when it was his turn to spend time with his child at the park or sports arena. Therefore, each parent will experience the loss in different ways and at different times. Although times are changing, sex-role socialization affects the way in which men and women handle grief. Traditionally, women have been socialized to express emotions as necessary to grief work. Bereaved moms are likely to have ample opportunities to talk and to cry in the company of other women. Men are less likely to get the chance to share their feelings, and even if the time and place are right, still there is the social expectation that they will control emotions and hold back tears. These differences may put the couple completely out of sync in their grief process. While parents are investing time and energy in grieving, other relationship issues may be put on the back burner rather than dealt with as they arise. But when not addressed, those day-to-day problems tend to accumulate and add to the weight and stress of grief. The danger, then, is that one or both partners will have a bursting of the emotional wall resulting in possible misunderstandings and heightened feelings of helplessness, loss and isolation. The death of a child is a major life crisis that undoubtedly changes both the parents and their relationship. But by communicating and giving each other permission to grieve as individuals, bereaved parents can make it to the top of their mountains and on down the other side, united and strong in their precious shared memories of the child they bore, loved and lost. The grief process, as objectively studied and documented by researchers and clinicians, is comprised of a series of stages: shock and denial, anger, depression, acceptance and renewed hope. Having bounced back and forth between all of these phases, I can attest to their validity. Now I would like to take the liberty of summarizing the grief process from a subjective, personal point of view using a new paths framework. Numbness when our minds shut down lest they explode from the pressure of the truth: he is gone and will never return. Emotions of sadness, despair, anger, yearning, guilt, envy - ever changing, confusing, overwhelming. Work - the hardest work imaginable, even beyond imagination - and yet it is work that must be done. Patience, perseverance, and prayer to get through the pain - pacing ourselves while reaching outwards and upwards for support and guidance. Acceptance ofreality; awareness of the complexities of grief; anticipating thehighs and lows and, at long last, moving on. Time alone does not heal, but as we face grief head on, taking one step at a time, we will heal ourselves. Hope in the future, trusting in ourselves that the seed of faith planted deep within every human being will bring us through the darkest of days. Seeing - not just looking, but really seeing the wondrous beauty of our world: bursting buds, soft green shoots piercing up through a blanket of dead leaves; robins gathering straw for their nests; looking towards heaven at the sun, moon and stars and knowing beyond a shadow of a doubt that there is so much more than meets the eye and so much that passes our human understanding. When death touches our lives, it changes us and leads us down new paths. Soon after my loss, I heard the grief process described as a journey to the top of a mountain. I doggedly clung onto that image as I travelled upwards through frightening, unfamiliar territory. Thankfully I found a peaceful new path; and so will you. As was the case with Pandora's otherwise empty box, human hope is constant. Week 45 - And on Down the Other Side My nephew, now the grown man I mentioned in several columns, wrote: "Life is like walking down a wooded trail, trying to guess where you're going from the markers laying behind." I believe that for everything that happens in life there is a reason, even though it may elude us at the time. Only now, as I look back over the past two years, do I begin to understand why my daughters and I moved to Jarvis eight months after Mike's sudden death. Actually, I could say that Jarvis chose us, beginning with a Sunday drive to Lake Erie and a pit stop at Mr. Mugs where we picked up a copy of The Haldimand Press. An advertisement for a farm house to rent brought us to our country retreat with its quiet trails along the Sandusk Creek - a perfect setting in which to wander and ponder the meaning of life while advancing along my grief path, one small step at a time. One day while out in the bush and thinking about the roller-coaster ride of grief, I began to write to try to make sense of my mood swings, the craziness and yet hope, and the changes that had occurred since our loss. It dawned on me then that I might help myself and others by sharing my experiences and new-found knowledge. Thus my column was born, written for the most part on a grassy bank by the creek. It was not merely coincidence that my work first appeared in aforementioned newspaper, the very publication that brought us to Jarvis. Nor is it a coincidence that I write my last two columns as we make our final plans to leave our country home. I still do not understand why my son had to die. Perhaps in time I will. But I do know that my paths in this Jarvis bush have led me to my mountain peak. And now, as I look into the future, I am drawn to another place. Again my daughters and I move on in faith, not knowing exactly where or why but trusting that our destination and the tasks awaiting us will become clear in time. Next week in my final column of the series I will leave you with a short piece that was read at my son's memorial service. May it, as I hope my writing has been, also be a source of comfort and inspiration for all that suffer the pain of loss. Week 46 - A Fond Farewell In the bottom of an old pond lived some grubs who could not understand why none of their group ever came back after crawling up the stems of the lilies to the top of the water. They promised each other that the next one who was called to make the upward climb would return and tell what happened to him. Soon one of them felt an urgent impulse to seek the surface: he rested himself on top of a lily pad and went through a glorious transformation which made him a dragonfly with beautiful wings. In vain he tried to keep his promise. Flying back and forth over the pond, he peered down at his friends below. Then he realized that even if they could see him, they would not recognize such a radiant creature as one of their number. The fact that we cannot see our friends or communicate with them after the transformation which we call death is no proof that they cease to exist. This column series is dedicated to my son, MichaelPaul Phillips.
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