Pediatrics - Good Grief Program at BMC

Pediatrics – Good Grief Program

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Talking With Children About Loss

Read an Excerpt from Chapter One

Chapter 1
I Was a Forgotten Mourner

Death and loss are vital processes of life. Kids face many losses during the course of their everyday lives. Every fifteen minutes, a baby dies. Every four hours, an adolescent takes his or her life by suicide. Every day, 13 children are victims of homicide. Every minute, an adult with cancer dies. Every hour, 85 adults with heart disease die. Every day, 190 adults die in accidents.

In the early 1980s, I worked with my mentor, the late Dr. Sandra Fox, to create the Good Grief Program. Sandra was the chief of social work at the Judge Baker Children's Center, the mental health facility affiliated with Children's Hospital and Harvard Medical School in Boston. After her untimely death in 1990, I became director of this program. During the workshops I conduct, I talk about how youngsters mourn and how adults are critical to their recovery and healing process. I counsel children and their families privately, work with hospitalized youngsters, and speak nationally to groups of parents, physicians, nurses, psychologists, funeral directors, and law-enforcement officials. In many instances, I'm called to stabilize and manage communities in crises. Because our society is unable to process children's grief, a tragic death can grind families, schools, and towns to a halt.

Is Good Mourning an Oxymoron?

There was next to nothing in the grief literature of the late 1970s and early 1980s about how kids respond to loss. Today, thanks to our ability to look at youngsters with life-challenging illnesses, particularly those with cancer, we know much more about how they perceive, understand, and cope with the death of a loved one or friend. We perform research today that we didn't do fifteen or twenty years ago because kids with cancer didn't live long enough for us to observe how they, their families, and their friends confronted loss. For example, what happens to the siblings and friends of a child who dies from leukemia? What happens to this child's family as a psychosocial unit, and how do they mourn her death?

Dr. Sandra Fox dedicated much of her fifty years to those beset by losses. From her work with children who suffer abuse and deprivation of many kinds, Sandra observed and defined their mourning behavior. She outlined four tasks that they work through as they mourn: understanding what caused the loss, grieving or experiencing the painful feelings associated with the loss, commemorating the value of the loss, and going on with life by accepting and integrating the loss psychologically and emotionally within themselves.

Bill Worden, a colleague of Sandra's, has defined mourning as the entire process of separating from the person who has died and adapting to the loss. Sandra stressed that we must assist kids in this process for two reasons: (1) they are not mature enough psychologically to acquire adequate coping skills on their own and (2) they look to us, their caregivers, for help during each developmental stage of childhood. These stages include preschool, latency, preadolescence, and adolescence, which span the ages between three and young adulthood. To ensure that children develop and master emotional skills as they process an initial loss and then face perhaps more profound ones in the future, caregivers have three major functions:

  1. To foster honest and open relationships with children
  2. To provide a safe and secure space in which children can mourn
  3. To be role models of healthy mourning

Because life doesn't progress in a linear fashion, kids don't first understand and then grieve, commemorate, and go on with life one task at a time. Neither do adults. Rather, our thoughts and emotions surge, ebb, and intersect like waves as the minutes, hours, weeks, and months of mourning progress. A sudden accident, suicide, or murder generates significantly different issues for kids than an anticipated death or a divorce. As they face the pain that a loss generates, youngsters work through the four tasks in small increments, which flow into one another until they have recovered from their loss.

In Motherless Daughters, Hope Edelman's message echoes that of Sandra Fox's: The single most important factor that helps mourning kids "become emotionally adjusted, competent adults is the active involvement of at least one stable adult who cares." As Rabbi Grollman says so eloquently, "Grief shared is grief diminished."

We might not always hear our youngsters' cries, but we must be willing to listen and watch for what they say and don't say. If we pay attention, we will learn what they need to experience good mourning. Tummy aches, thumb sucking, moodiness, angry outbursts, tearful anxiety, and mature behavior can either mask or reveal their psychic pain and other grief feelings. Our job is difficult because, in many cases, it challenges us to look at our actions and alter our past learning patterns and behavior. If we meet this challenge, we bring families, adults, and children of all ages together. If we deny any loss, conceal it from our kids, or don't value their expressions, they will mirror our unenlightened behavior, possibly suffer one or many emotional problems, and become forgotten mourners.

We need to "get into the same lifeboat" with our kids, put on our life vests, and have our oars with us. Together, in this survival craft, families can ride out the storm of loss without sinking. The flip side of this metaphor is frightening--to send our children off into unknown, dark waters alone and without survival gear. Ironically, we would never knowingly do such a thing; yet, our inability to adequately recognize the significance of the many losses that they face in the normal throes of growing up isolates them upon unsafe and desolate seas. The Chinese pictograph for the word crisis is composed of two symbols, one that depicts our word for danger and the other, our word for opportunity. We understand all too well the danger imbedded in the crisis of a loss, but the opportunity is often hidden. This book invites you to seize the opportunity that lies concealed in all losses our kids face. If we charter the boat of mourning with our children, they will realize that only by confronting death and loss and integrating them into their life can they truly embrace living and loving relationships.

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Boston Medical Center
Department of Pediatrics
Good Grief Program
Vose Hall, 403
92 East Concord Street
Boston, MA 02118


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