Grief and the Disappearing Self: An Additional Note on Loss in Children: Becoming what might have been
Rea L. Ginsberg, LCSW-C, ACSW, BCD
Solitude is fine but you need someone to tell that solitude is fine. ~~ Jean-Louis Guez de Balzac, Dissertations ( 1665)
An ancestral insight: We Need Others.
Childhood bereavement changes the course of the future. All bereavement transforms the survivor’s future. Parent-loss in childhood is especially powerful because of the child’s immature, undeveloped psychological defenses and his status of enormous dependence. 
Customarily, parents make a fundamental promise to their children, to take care of those children throughout their period of need for parental care. This promise sounds like “forever” to the child. He firmly assumes its truth. It is comforting and reliable. The parents are seen as infinitely trustworthy. Most children find it impossible to picture a world in which such a parent no longer exists.
When the promise proves false and the parent dies, the child suffers more than one loss:
The promise of “forever” feels like a lie, a betrayal;
The parent disappears permanently and the child feels abandoned;
The child may also feel outraged that the lost parent would commit the crime of abandonment;
The child often engages in active search behavior, believing consciously or unconsciously that death is a reversible condition and that the beloved dead parent is retrievable;
When search fails to reunite, some feelings of helplessness and hopelessness are inevitable;
The grief of the remaining parent may make him unavailable to support the child for critically important periods of time;
The remaining parent may not be able to grieve adequately or empathize with the child’s feelings of loss, leaving the child to feel a partial loss of this parent as well;
The remaining parent may hold unrealistically high expectations for the younger child’s understanding of death, leaving the child with feelings of heightened confusion, humiliation, and outright anger;
The child may fear that this parent will also die;
The child may lose self-esteem, believing himself guilty for the death of the deceased parent;
The child may become fearful of his own supposed omnipotence; that is, he fearfully presumes the death is caused by a flash of his angry wish for it;
The child may worry that he himself will also die soon and for uncontrollable and incomprehensible reasons;
The child may wish to die in hopes of reunion with the lost parent in the world of the dead; 
He may regress, behave in more infantile ways, and become fearful of being alone; the child’s age matters, here and elsewhere;
Many children temporarily lose their physical health because of (a) high-stress factors such as sudden and unwelcome alterations in customary routines, change of caregiver(s), sleeplessness, and disrupted eating patterns/appetite loss; (b) generalized anxiety caused by separation from the deceased parent;
Additionally, take into consideration the rudimentary defense system of the child, his immature personality; defenses are mental processes which attempt to exclude unwelcome information.
It is like the perfect storm to produce ambivalence, anger, self-reproach, and fear, tinged with suspicion, lack of trust, and a cynical worldview. Heredity proposes; development disposes.  Some researchers would suggest that these combined factors approach the level of toxic stress on the child’s developing brain. 
The nature of bereavement is composed of intricately interconnected interwoven parts. It is complex. Many common characteristics certainly are shared by those who grieve. Yet, different people may respond to loss in widely varied ways, depending on the specific circumstances and personality of each.
In some grieving children, the undeveloped Self soon becomes enveloped in skepticism of others’ motives. The child questions if others will also lie and die or otherwise disappear. Trust is difficult to reestablish and achieve. This wary view of others tends to widen, to expand, to eventually include the whole human world. It may affect every corner of the child’s life. It can easily last a lifetime if not confronted and treated. 
Suspicion is defensive. It becomes a magic trick for the child. It is his effort to protect himself from the grief of even more losses. The near-term reward is instant and high. It works for him, but it arrests significant aspects of his further psychosocial development. It places a purposeful but ultimately unhealthy – if not useless – barrier between himself and all others. In this way, it inadvertently heightens his grief and isolation.
In short, suspicion is a problem-solving effort. The problem is pain from grief. The solution is avoidance of more grief pain. Suspicion becomes the route to avoidance. This suspicion is harmful.
Potential goes unfulfilled. What might have been self-actualization is forestalled. The child’s true and highest potential for healthy psychosocial growth is restrained by mistrust. It is submerged, hidden in a morass of suspicion. As he moves into adulthood, mistrust remains a prominent factor in his relationships with others.
He inspects others’ reliability intently for “proof” that his mistrust has merit. He convinces himself that his often-mistaken perception is accurate and that mistrust was warranted. Suspicion is frequently confirmed, according to his judgment. Virtually no one escapes his flawed scrutiny. The closer the relationship, the more the mistrust comes to the fore. For him, intense closeness equals the excruciating pain of loss; therefore, early and extreme investigation of others is required. Even the grieving child himself does not recognize his positive growth potential. He is too busy wielding the long sword of his self-protective mistrust. Also, this mindset often affects intellectual development adversely. The adult stays stuck in his past, in his grief-laden childhood. The past is certain prologue. 
This is the disappearing Self that grief can produce. It is tragic and lonely. It is tragic because true and deep closeness to other people cannot usually occur. Then, the consequential accompanying growth and sense of safety are largely blocked. Grief imprisons the mind. It is lonely because parent-loss feels lonely beyond comprehension, and the healing work of grief has not been accomplished. The experience of “feeling good” again is missing. 
Healthy, wholesome growth is not lost, however. It is only hidden. Grief can be treated by people who care, people who are not necessarily/only licensed professional counselors and therapists. Once upon a time, friends and other important acquaintances (e.g., teachers and spiritual leaders) did this for one another. Psychotherapy was later called “the purchase of friendship.” Of course, sensitive family members also helped each other.
Even the most grieved and untrusting of people can reemerge from their disappeared state of mind. People are resilient; foster it, promote it, nurture it. Give sorrow words. Talking helps coping. Tell the truth and answer the questions. “Some research suggests that people recover from traumas faster simply if they can talk about them.”  Make promises and then keep them; it builds confidence and trust. Support groups may also assist. Grief work matters.
.”…he who remains passive when overwhelmed with grief loses his best chance of recovering elasticity of mind.” 
Healing work takes some encouragement and gentle support from others who know how to listen and when to respect silence. It takes showing up, being there, being available and reliable and stable. It takes patience and lots of repetition. Progress does not travel in a straight line. It takes compassion, if not empathy as well. H. D. Thoreau wrote, “Could a greater miracle take place than for us to look through each other’s eyes for an instant?”
The warmth of thoughtful kindness and honest reassurance goes a long way in combating suspicion. The qualities of sincerity and freedom from deceit have remedial power. Self-respect and inherent dignity are enhanced in the presence of others who care; human relationships are central to strength and growth. And it may take a village, a community of support, to help in healing the wounds of childhood. A strong support system eases the pain and provides relief. All of this can transform lives. It gives Hope.
It is worth the effort, the energy and determination. It is also the healer’s finest legacy, the mark he leaves on others’ lives.  That is incentive enough for him to proceed. What counts is the courage to continue.
Potential unbound from bonds of mistrust and unprocessed grief is possibility finally on the way to realization.
It is never too late to be what you might have been. ~~ George Eliot
1. “When his parent dies, a child finds himself in a unique situation because of the special nature of his ties to the deceased. An adult distributes his love among several meaningful relationships – his spouse, parents, children, friends, colleagues – as well as in his work and hobbies. The child, by contrast, invests almost all his feelings in his parents. Except in very unusual circumstances, this single relationship is therefore incomparably rich and intense, unlike any close adult relationship. Only in childhood can death deprive an individual of so much opportunity to love and be loved and face him with so difficult a task of adaptation….The death of a parent engenders a longing of incomparable amount, intensity, and longevity.”
In this context – that of a child losing his parent – it is also interesting to note that the words “bereave” and “rob” stem from the same root. The child is bereaved, deprived, robbed of his parent.
2. “Since children have greater difficulty even than adults in believing that death is irreversible, hopes of reunion with the dead parent are common. They take one of two forms: either the parent will return home in this world, or else the child wishes to die in order to join the dead parent in the next.”
4. Center on the Developing Child, Harvard University, 2016: “Early experiences affect the development of brain architecture, which provides the foundation for all future learning, behavior, and health….Adverse experiences early in life can impair brain architecture, with negative effects lasting into adulthood….The interactions of genes and experience shape the developing brain…Ultimately, genes and experiences work together to construct brain architecture.” http://developingchild.harvard.edu/science/key-concepts/brain-architecture ;
Center on the Developing Child, ibid: “The future of any society depends on its ability to foster the healthy development of the next generation. Extensive research on the biology of stress now shows that healthy development can be derailed by excessive or prolonged activation of stress response systems in the body and brain. Such toxic stress can have damaging effects on learning, behavior, and health across the lifespan.” http://developingchild.harvard.edu/science/key-concepts/toxic-stress .
5. “Whether an author is discussing the effects of loss on an adult or a child, there is a tendency to underestimate how intensely distressing and disabling loss usually is and for how long the distress, and often the disablement, commonly lasts. Conversely, there is a tendency to suppose that a normal healthy person can and should get over a bereavement not only fairly rapidly but also completely….I shall be countering those biases. Again and again emphasis will be laid on the duration of the grief, on the difficulties of recovering from its effects, and on the adverse consequences for personality functioning that loss so often brings. Only by taking serious account of the facts as they seem actually to be is it likely that we shall be able to mitigate the pain and disability and reduce the casualty rate.”
John Bowlby, Loss: Sadness and Depression, op. cit., p.8.
6. This mistrust and suspicion is not paranoia, nor is it paranoid personality disorder. It is strong fear caused by the unresolved grief from childhood. It might be called “pseudo-paranoia” because of the suspiciousness involved. In its strictest psychodynamic sense, paranoia is different. It is a psychotic (severe; schizophrenic) mental disorder characterized by the slow deterioration of personality and involving delusions of persecution (“someone is plotting against me”) and grandeur. Auditory hallucinations may also be present.
7. How long does it take to recover from grief? Maybe two weeks. So say the American pundits. Maybe a lifetime. So say the bereaved, those who have loved and lost. They know better. They know best. They are the folks “on the ground,” the real people in actual distress. They will be heard in the final analysis.
Does the mourner “recover” or does he heal into growth and greater strength? Who cares to look inward for insightful answers? Self-examination is a bold, brave act. Not everyone has that daring. The resulting Self-awareness hurts a lot sometimes, for the sake of increased peace and joy in living and loving – feeling good in a whole new way, because death changes the minds of those who live on.
“Feeling good is hard to describe and define, but is readily recognized. It is characterized by pleasure in living, is often accompanied by a heightened sense of bodily and mental well-being, by an ability to extend oneself to others and to initiate and enjoy harmonious interactions with them, by an ease and comfort in giving to and taking from life what it has to offer, and by being creative in thought, word, or deed, however humble a form it may take. Feeling good is usually experienced in more simple or complex ways at all levels of development…It is a treasured feeling, sorely missed when absent.”
Erna Furman, “On Fusion, Integration, and Feeling Good,” The Psychoanalytic Study of the Child, New Haven: Yale University Press, 1985, Volume 40, pp. 81-82.
8. News Release, Stanford University News Service, 8/29/1994, http://news.stanford.edu/pr/94/940829Arc4145.html (We have known this literally for many centuries. Modern research confirms ancient wisdom, now with interesting scientific explanations.)
9. Charles Darwin, The Expression of the Emotions in Man and Animals, quoted in John Bowlby, Loss: Sadness and Depression, op. cit., p. 345.
10. “We never know the good we do, still less the chain of consequences to which it gives rise. But this is the only legacy worth leaving: the trace we leave on other lives, and they on others in turn. Sometimes a single act…can reverberate in incalculable ways.”
Rabbi Lord Jonathan H. Sacks, To Heal a Fractured World: The Ethics of Responsibility, New York: Schocken Books, 2005, p. 236. Sacks’ website: http://www.rabbisacks.org
Frequently, this is also the start of a virtuous circle of caring.
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We Need Others.
The act of listening can transform a life.
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Image credit, top: “Figures and dog in front of the sun,” 1949; Joan Miro, Spanish painter/sculptor, 1893 - 1983; www.brisasptso.org
Childhood Bereavement  Rea L. Ginsberg, LCSW-C, ACSW, BCD
Grief is not optional. Shared sorrow helps healing. We need others.
In the case of childhood bereavement, the death of a parent, the term “bereaved caregiver” no longer applies. The tables are turned. The child is indeed bereaved, but he himself is in need of a caregiver.
It seems senseless to debate which types of grief are the worst. Which are the hardest to bear. Every form hurts so very far beyond normal limits, beyond ordinary words. Profound sadness. It takes our breath away. It aches that much. Every form requires extraordinary coping skills. Every form holds its hazards. However, this childhood form does appear to be among the very worst.
“When his parent dies, a child finds himself in a unique situation because of the special nature of his ties to the deceased. An adult distributes his love among several meaningful relationships – his spouse, parents, children, friends, colleagues – as well as in his work and hobbies. The child, by contrast, invests almost all his feelings in his parents. Except in very unusual circumstances, this single relationship is therefore incomparably rich and intense, unlike any close adult relationship. Only in childhood can death deprive an individual of so much opportunity to love and be loved and face him with so difficult a task of adaptation….The death of a parent engenders a longing of incomparable amount, intensity, and longevity.” 
The child’s loss of a parent is one of the most difficult forms of bereavement. The mind of the child is immature. It is filled with magic, denial, narcissism, and self-reference. It says he is omnipotent and responsible for all external and internal events. If he is omnipotent, all-powerful, then his thoughts and/or actions must have caused the death. “Bad boy!” he imagines. Furthermore, he may well believe that the dead parent left him because he is unlovable. He may wonder about, and fear for, his own survival and death. Annihilation fears. Reality testing has not been mastered. Abstract thinking is only embryonic. The understanding of catastrophe has nothing much to do with reasoning. It is completely a matter of emotion. Emotional coping skills are primitive, undeveloped. He is more likely to express his feelings in physical actions rather than in words. Hyperactivity is a frequent defense against grief and anxiety. Adequate, nuanced verbal vocabulary is still narrow and unformed. The concept of “waiting” is virtually nonexistent. Postponement of gratification is merely a work in progress. It is not yet a reality. All of these are some of the reasons that the bereaved child’s needs are so special.
“The ability to love – like other human faculties – has to be learned and practiced. Wherever, through the absence of or the interruption of personal ties, this opportunity is missing in childhood, all later relationships will develop weakly, will remain shallow. The opposite of this ability to love is not hate, but egoism. The feelings which should go to the outside objects remain inside the individual and are used up in self-love. This is not what we want to produce.” 
Death makes no sense in these formative years. The child’s experience tells him: an object which disappears may eventually reappear. Fear tells him otherwise. Separation anxiety is intense. This thought of reappearance co-exists with the fear and outrage of abandonment. Fear of – and outrage about – abandonment become a sustained, screaming, breathless reality in the case of death. The loss is far-reaching. Recovery is arduous, exhausting, and hard to accomplish. The death of a parent is life-altering on a permanent basis. It is a severe emotional wound. It is traumatic.
“Although we know that, after such a loss, acute mourning will subside, we also know that a part of us shall remain inconsolable and never find a substitute. No matter what we believe may fill the gap…we will nevertheless remain changed forever…” 
From their many experiences with children, child psychotherapists tend to agree that the child’s mourning process never does entirely end, nor should it. The mental representation of the lost loved one, the memories and an accompanying degree of longing, remain with the child through childhood and adulthood – throughout his lifetime.  The lost parent remains loved and missed. Of course the bereavement process evolves, and remaining fragments come under far better psychological control and management as the child’s thinking matures. Mourning resolves but nevertheless, vestiges continue for a lifetime.
This troublesome outlook for the child can be mitigated by the understanding and compassionate presence of the other parent or another adult. Even an older sibling can soften the hardship. Someone must be there to receive and relieve the child’s distress. The child cannot be left alone to cope with loss and still remain healthy – both in mind and in body. Sorrow must be shared. Every person needs to know he is not alone with grief. The child is especially vulnerable and needy in this respect.
The optimistic side of this equation is the malleability of the child’s mind. In important ways, he is easily influenced, persuaded. His thinking and feelings can be shaped by sympathetic others. The “bad boy” of the child’s imagination requires immediate recognition and attention by at least one caring adult. If not immediate, the child’s sense of guilt and self-loathing over the death only grows stronger. These feelings then become increasingly less open to remedy. The fear and rage need the mature balance and moderation of others’ views. To save life and sanity, it takes only one human being who cares. 
Children draw great strength from their caregivers. The child needs the love and gentle guidance of a perceptive, patient, and capable caregiver. The caregiver must have a strong, intuitive understanding of children and their varied ways of expressing emotions. The adult was once a child. The caregiver should be in touch with the child within himself. That is one primary route to the necessary and sufficient comforting of the bereaved child. Also, “the child…profits especially when the [surviving] parent can reassure him that the family will remain together, that his needs will be taken care of as best possible, and that he will be told step by step as each arrangement is planned.” 
The caregiver, perhaps the surviving parent, functions as a protective “auxiliary ego” for the bereaved child. The strength and reassurance of the caregiver deeply influence the child’s ability to cope with the loss. Children in wartime have been the subject of many psychological studies. We know from those studies that children were least traumatized when the primary caregiver – usually but not always the mother – remained close, loving, calming, and comforting. Children’s reactions to loss depend mainly on the reactions of the primary caregiver. “Analytic date show us, time and again, that the child’s healing process is greatly facilitated when the [parent] is not only physically available but emotionally aware of the child’s experience, active in assisting him with integration, and supportive of his efforts….Prevention is so much easier than cure….Not all but many traumas can be avoided.” 
Experiences tend to build on each other. Certainly, if this is the child’s first major experience with bereavement, it may well set the stage for many future experiences with death and dying. An appropriate grief experience could help the child to manage future loss experiences successfully. The child at any stage of development possesses both character strengths and character weaknesses. Those and the impact of the psychosocial environment determine the outcome of bereavement.
[The importance of chronological age and developmental stage are emphasized.] “The total character of the child and…the totality of environmental circumstances…determine the outcome of the experience….The interaction between internal and external forces decides between the possibility of normal developmental progress and the incidence of pathological developmental distortion or arrest.” 
If the child’s caregiver is the other parent, we have come full circle, returning to the bereaved caregiver. Grief is not optional.  The caregiver must attend to his own grief and to the grief of his child. Perhaps, in some important sense, parent and child comfort, soothe, and reassure each other. They support one another. The feeling of deep sorrow is shared. The process and progress of the caregiver’s bereavement is then highly significant not only for himself but also for his child. The child’s mastery of his situation depends substantially on the caregiver. It is a large responsibility. Honesty and openness are virtually always good policy with children. The subject of death will carefully follow this pathway – when the caregiver is strong enough and wise enough to pursue it. He will know intuitively how to listen well and respond to the child’s expressions of grief.
Children are resilient despite obstacles. Grownups are, too. Children draw healthy, lasting equilibrium from their caregivers and from the memory of the loved one. Parent and child honor the life of the lost loved one with their enduring love and their continued lives. Love is bigger than Death. 
“Feeling good is hard to describe and to define, but is readily recognized. It is characterized by pleasure in living, is often accompanied by a heightened sense of bodily and mental well-being, by an ability to extend oneself to others and to initiate and enjoy harmonious interactions with them, by an ease and comfort in giving to and taking from life what it has to offer, and by being creative in thought, word, or deed, however humble a form it may take….It is a treasured feeling, and sorely missed when absent.”  This feeling-good is the aim of appropriate grief resolution. It is part of the transformation.
This childhood form of bereavement holds perhaps the greatest potential for healthy growth. Pleasure in living. Love of self and others. Creativity. It is the hidden value of adversity. The hint of later beauty, sensitivity, and wisdom in adulthood. Grief – suffering – has its own very special, enduring bonuses.
No hurry to heal. No pressure to “snap out of it.” Honesty and openness. Love. Memory. A firm, soothing hand to hold. Talking. It takes only one human being who cares. That is the route to strength and growth.
** "If ever there is tomorrow when we're not together... there is something you must always remember. You are braver than you believe, stronger than you seem, and smarter than you think. But the most important thing [to remember] is, even if we're apart... I'll always be with you." ~~ A. A. Milne
* * * * References:
1. A group of highly sophisticated psychotherapists/researchers working with bereaved children wrote:
“Throughout the work, in our direct contacts with our patients and their families, in our private thinking and in our research discussions, we lived with the intense distress, pain, and anguish engendered by bereavement. We have come to understand that this emotional distress is an inevitable burden for all who work with bereaved children. It is essential in facilitating appropriate empathy and insight, and helpful in integrating an intellectual grasp of the psychic processes within the patients’ personalities. Only those willing and able to bear the impact with feeling can hope to work with bereaved children fruitfully and to understand them scientifically.”
Erna Furman, A Child’s Parent Dies: Studies in Childhood Bereavement, New Haven and London: Yale University Press, 1974, p. 9.
2. Erna Furman, ibid., p. 12 & p. 16.
3. Anna Freud and Dorothy T. Burlingham, War and Children, New York: Medical War Books, 1943, p. 191.
4. Sigmund Freud, letter to Binswanger, 1929, in: E. Freud, editor, Letters of Sigmund Freud, transl. Stern & Stern, New York: Basic Books, 1960, p. 386. With special thanks also to Joanne Cacciatore, PhD, for pointing to this quote and for her uniquely beautiful word picture showing these thoughts: private e-mail communication, 28 June, 2013. [Please see picture below]
5. Marie E. McCann and Edward J. Schiff, MD, “The Process of Mourning,” in Erna Furman, op. cit., p. 52.
6. Elisabeth Kubler-Ross, MD, On Children and Death, New York: Macmillan Publishing Company, 1983, p, 19. [Please see also: www.ekrfoundation.org]
7. Erna Furman, op. cit., p. 20.
8. Erna Furman, “On Trauma,” The Psychoanalytic Study of the Child, New Haven: Yale University Press, volume 41, 1986, pp. 203 & 207.
9. Anna Freud, Forward to: Erna Furman, A Child’s Parent Dies: Studies in Childhood Bereavement, New Haven and London: Yale University Press, 1974.
10. Monica Williams-Murphy, MD, private e-mail communication, 5 July, 2013. [Please see also Dr. Murphy’s blog at website: www.oktodie.com]
11. Joanne Cacciatore, PhD, private e-mail communication, 4 July, 2013. [Please see also the website of the MISS Foundation: www.missfoundation.org]
12. Erna Furman, “On Fusion, Integration, and Feeling Good,” The Psychoanalytic Study of the Child, New Haven: Yale University Press, volume 40, 1985, pp. 81-82.
“You will come to a place where the streets are not marked. Some windows are lighted, but mostly they're darked. But mostly they're darked. A place you could sprain both your elbow and chin! Do you dare to stay out? Do you dare to go in? How much can you lose? How much can you win?” ― Theodor S. Geisel