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