Healing Children’s Grief: Surviving a Parent’s Death from Cancer Grace Hyslop Christ OXFORD UNIVERSITY PRESS Healing Children’s Grief This page intentionally left blank Healing Children’s Grief Surviving a Parent’s Death from Cancer Grace Hyslop Christ New York • Oxford OXFORD UNIVERSITY PRESS 2000 Oxford University Press Oxford New York Athens Auckland Bangkok Bogotá Buenos Aires Calcutta Cape Town Chennai Dar es Salaam Delhi Florence Hong Kong Istanbul Karachi Kuala Lumpur Madrid Melbourne Mexico City Mumbai Nairobi Paris São Paulo Singapore Taipei Tokyo Toronto Warsaw and associated companies in Berlin Ibadan Copyright © 2000 by Oxford University Press Published by Oxford University Press, Inc., 198 Madison Avenue, New York, New York, 10016 http://www.oup-usa.org All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Oxford University Press. Library of Congress Cataloging-in-Publication Data Christ, Grace Hyslop. Healing children’s grief : surviving a parent’s death from cancer / by Grace Hyslop Christ. p. cm. Includes bibliographical references. ISBN 0-19-510590-7 (alk. paper) — ISBN 0-19-510591-5 (pbk. : alk. paper) 1. Grief in children. 2. Grief in adolescence. 3. Bereavement in children. 4. Bereavement in adolescence. 5. Parents—Death—Psychological aspects. 6. Children and death. 7. Teenagers and death. I. Title. BF723.G75 C58 2000 155.9′37′083—dc21 99-015342 Printing (last digit): 987654321 Printed in the United States of America on acid-free paper This book is dedicated to the families of the parents who died. Their stories are a legacy of healing they left for all of us. This page intentionally left blank Contents List of Tables and Figures ix Foreword xi Acknowledgments xv Introduction xvii 1. Mother and 3-Year-Old Daughter 1 Diagnosis and Treatment 1 Terminal Stage 2 Death and Family Rituals 3 Bereavement and Reconstitution 5 Cascade of Events 6 Conclusion 8 2. Childhood Bereavement Studies 11 Evolving Bereavement Models 11 Traumatic Stress 14 Studies of Bereaved Children 16 Traumatic and Anticipated Death and Divorce 21 Summary 21 3. Stages of the Illness and Child Development 24 Psychosocial Stages of Cancer 24 Contribution of Development 27 Summary 32 4. Study Sample, Intervention, Bereavement Model, Methodology 33 Sample 33 Intervention: Data Collection 34 Bereavement Outcome Model 37 Methods 42 5. Children 3–5 Years of Age: Themes 46 Developmental Themes of Preschool Children 46 Patterns of Responses in Preschool Children 48 Recommendations for Professionals and Caregivers 58 6. Children 3–5 Years of Age: Narrative 61 Mother and 4- and 7-Year-Old Daughters 61 7. Children 6–8 Years of Age: Themes 71 Developmental Themes of Early School-Age Children 71 vii viii Contents Patterns of Responses in Early School-Age Children 74 Recommendations for Professionals and Caregivers 89 8. Children 6–8 Years of Age: Narratives 92 Mother, 7-year-old son and 4-Year-Old Daughter 92 Father and 7- and 20-Year-Old Daughters 98 Outcomes 106 Discussion 108 9. Children 9–11 Years of Age: Themes 109 Developmental Themes of Later School-Age Children 109 Patterns of Responses in Later School-Age Children 112 Recommendations for Professionals and Caregivers 126 10. Children 9–11 Years of Age: Narratives 129 Father and 10-Year-Old Daughter 129 Mother and Three Children, Aged 7, 10, and 11 Years 138 Outcomes 146 Discussion 148 11. Children 12–14 Years of Age: Themes 150 Developmental Themes of Early Adolescence 150 Patterns of Responses in Early Adolescence 154 Recommendations for Professionals and Caregivers 166 12. Children 12–14 Years of Age: Narratives 170 Father, 12-year-old girl and 15-Year-Old Boy 170 Mother and 12-Year-Old Son 180 Outcomes 187 Discussion 190 13. Children 15–17 Years of Age: Themes 192 Developmental Themes of Middle Adolescence 192 Patterns of Responses in Middle Adolescence 195 Recommendations for Professionals and Caregivers 210 14. Children 15–17 Years of Age: Narratives 214 Father, 16- and 13-Year-Old Daughters and a 15-Year-Old Son 214 Mother and 16-Year-Old Daughter 224 Outcomes 230 Discussion 232 15. Conclusion 234 Mourning 235 Outcome 239 The Untold Stories 242 Combining Qualitative and Quantitative Approaches 243 Future Directions 243 Bibliography 245 Author Index 253 Subject Index 257 List of Tables and Figures Table 2.1 Death, Divorce and Traumatic Stress: Differences and Similarities 22 Table 4.1 Demographic Characteristics of Parents 35 Table 4.2 Children and Adolescents in This Sample 36 Table 4.3 Children’s Outcome by Gender of Child and of Surviving Parent 42 Figure 4.1 Bereavement-Outcome Model 37 [...]... loyalty to their biological parent and retain a special and primary place for that parent when the surviving parent dates or plans to be married It was also hard for Rachel to accept Robert because she felt jealous sometimes She and Lisa had been a team” for four years, and now she had to share that special relationship When Rachel entered first grade, at age 6 she was a bright, highly verbal, engaging,... optimistic each time By now Rachel was 2 1/2 years old, and Joel and Lisa no longer talked hypothetically about Joel’s death Death had become a heart-wrenching certainty Terminal Stage Rachel was almost 3 years of age when Lisa visited the social worker on Joel’s hospital floor for advice about how to manage Rachel, who was reacting to Joel in a way that puzzled and upset both parents Several weeks earlier,... and planned a career that would give her maximum flexibility and time to bring up Rachel Dating was easy compared with thinking about a permanent relationship, which always made her anxious If one husband had died, it could happen again The trauma of an unexpected tragedy that occurs at such a young age is difficult to shake Cascade of Events Rachel’s relationship with Joel’s family became distant rather... provides important new information for the construction of theories about children’s adaptation to the traumatic experience of expected death from medical illness (and all that accompanies this in technological medicine and in specific family situations) The careful documentation of children’s adaptation to a parent’s death from cancer is also a model of research that can be extended to the consideration of... disturbed adolescents as arising from their early problems involving individuation and separation from the maternal figure (Masterson, 1972) In short, a developmental perspective, albeit primarily psychoanalytic, was an influential part of my understanding of mental health and mental illness The third important influence was my clinical work and research with cancer patients and their families at Memorial Sloan-Kettering... specialist after specialist Unhappily for everyone, Lisa and Robert finally separated when Rachel was 14 years old Although Rachel had resented Robert at first, she had become fond of him; in fact, she had adopted his surname in addition to Joel’s Robert had given her the stable family she had always thought she wanted When Lisa and Robert separated, Rachel was furious, feeling abandoned and rejected because... husband for myself It isn’t easy, but I need to date to find out what a person is like.” Rachel thought for a while, then said: “Don’t date at night Date when I am in school.” Rachel stopped talking easily about her father a year or two after his death When Lisa mentioned him, Rachel often adamantly announced that she did not want to talk about him As time went on, Lisa worked hard to complete an advanced... communicating was answering her questions about the illness and treatment as they were happening, rather than having to explain a sudden illness crisis that wasn’t attached to any concrete thing for her “I understand why parents are reluctant to tell their young children about a parent’s terminal illness The hardest part for me was realizing that I couldn’t protect Rachel from the pain of her father’s death. .. reconstitution that takes place after a parent’s death is not like putting Humpty Dumpty together again The surviving parent’s ministrations, preparation, love, support, and ability to understand and respond to the child’s despair are buffers that mitigate some of the ravages of the family tragedy and provide anchors that the child can use to construct a new Weltschauung, a view of the world that incorporates... adult patients (Abraham, 1927; Shafer, 1968; Volkan, 1981) Others added insights from the psychoanalysis of emotionally disturbed children (Freud, 1960; Furman, 1974) For example, Erna Furman observed that children as young as 3 years old had the capacity to mourn because they had attained object permanence (the ability to accept emotionally that they were separate from the parent and that the parent . Healing Children’s Grief: Surviving a Parent’s Death from Cancer Grace Hyslop Christ OXFORD UNIVERSITY PRESS Healing Children’s Grief This page intentionally left blank Healing Children’s. Aires Calcutta Cape Town Chennai Dar es Salaam Delhi Florence Hong Kong Istanbul Karachi Kuala Lumpur Madrid Melbourne Mexico City Mumbai Nairobi Paris São Paulo Singapore Taipei Tokyo Toronto Warsaw and. Press. Library of Congress Cataloging-in-Publication Data Christ, Grace Hyslop. Healing children’s grief : surviving a parent’s death from cancer / by Grace Hyslop Christ. p. cm. Includes bibliographical