Example Health Essay
When I was five, my grandmother passed away in hospital just before Christmas. She had been in the hospital for some time and was very elderly. As my sisters and I were at school, we could only visit the hospital at the weekend, whereas my mother and father would visit during the week. At weekends my sisters and I would be given the choice about going to the hospital with our father to visit, or to stay at home. I often chose to stay at home. I understood that my grandmother was old, however I did not understand how ill she was.
When my grandmother passed away, I felt guilty that I had not chosen to visit her. Although I knew that my grandmother had been ill for some time, I had not understood that she was coming to the end of her life, and it had also not been explained to me by the adults. I knew that death was irreversible, however because her death did not impact on my daily routine as my parents sought to maintain normality as far as possible. I found that my life continued as usual, without any major interruptions.
In the week leading up to my grandmother’s funeral I saw my father crying and remember that seeing my father cry made me feel both frightened and upset. I felt upset because I had never seen my father cry before, and I realised that he was suffering greatly. As a result of this, I tried to behave well at all times as I was worried that my actions would cause my father to cry again. I felt frightened because although my grandmother’s death had not had a large impact on myself, I could see that it was having a profound effect on those that I cared about. As I was only a small child, this was the first time that I had seen such a depth of emotion in those close to me, and I was not sure how to react to this.
Research has demonstrated that children, even very young children, are capable of grieving (Melhern et al, 2011). It is important to note that there are differences in the way that adults and children grieve. In particular, children are likely to show their grief in less direct ways than adults, and can move in and out of grief, almost grieving in bursts (Melhern et al, 2011). It is also important to realise that the child’s age, emotional maturity, circumstances of loss, and the level of relationship between the child and the person who has died are all important factors (Dowdney, 2008).
Piaget’s research demonstrated that toddlers and infants understand events in terms of direct experience, and that the dependable presence and emotional expression of loved people are more important than the language used (Piaget, 2013). Studies which have applied Piaget’s work have demonstrated that even children who cannot yet communicate verbally are aware of the distress of adults around them and are aware of the absence of a loved person (Himebauch et al, 2008). It can therefore be thought that not telling young children about the death of a family member will not protect them from the loss as intended, and will only prevent discussion.
This fits with Piaget’s work, who found that young children (between the ages of 3 – 6) do not think in logical sequences, and therefore have illogical explanations for events (Piaget, 2013). This is reflected in the difficulty they may have grasping that death is not reversible (Brown et al, 2008). Families often find it easier to help children after the loss of a grandparent, as they are often in an age group where death is more common (Brown et al, 2008). In my case, I did not have daily interaction with my grandmother due to geographical distance, however we did have regular contact at weekends. This may have meant that there were fewer obvious changes and reminders of the absence.
This is clearly not applicable to all children and cultures, where the grandparents may play a central role in the child’s life and in the family (Salloum, 2008). In these cases, the effect of the loss may be apparent as regression or behavioural problems in the child (Salloum, 2008). Ongoing discussion of the loss can provide the opportunity for children to reinterpret the death over the years as their cognitive comprehension grows (Salloum, 2008). Research has clearly demonstrated that the lack of a well-structured support system during the mourning period can lead to severe disruption of childhood development (Bonanno, 2004).
One study conducted in the United States found that out of 270 children taken to counselling after the death of a loved one and who lacked a well-structured support system, 66% demonstrated aggressive behaviour, 44% lacked social skills, and 18% had delayed cognitive, fine and gross motor development (McClatchy et al, 2009). However, it is not possible to determine from the study whether these children had developmental difficulties before counselling. If this is true, the quoted percentages may not be a true reflection of the impact of a lack of a well-structured support system.
There is also a clear impact on the academic abilities of children who have suffered loss Shear & Shair, 2005). In addition to this, children often have higher levels of absenteeism from school when a close relative is ill, which could have an impact on their academic performance. This impact on academic performance is often seen in children who have witnessed a traumatic death and subsequently develop post-traumatic stress disorder (Shear & Shair, 2005). I believe that my parents made considerable efforts not to disrupt the daily routines of my sisters and I, particularly around school. I think that this ensured that our academic performance did not suffer as much as it may otherwise have.
It is clear that children’s understanding of death develops in parallel with cognitive maturing throughout childhood (Cohen, 2011). The concept of death may develop at different rates in different children, but the developmental sequence seems to be the same (Cohen, 2011). For example, children below the age of five do not understand that death is irreversible, and will demonstrate this by asking when the person is coming back (Salloum, 2008). As a result of this, children at this age will have difficulty understanding abstract explanations of death, and such explanations such as saying the person has gone to sleep may result in fear of sleep (Cohen, 2011). It is therefore clear that although the concept of death is not fully developed in small children, there is little doubt that they still react strongly to loss at this age (Cohen, 2011).
This does not apply to my experience of loss, as I was slightly older; however it is clear that loss at even a very young age can have a lasting impression on children. Between the ages of four and six, it is thought that children begin to develop a biological understanding of life (Crenshaw, 2005). An example of this is knowing that parts of the body work to sustain life. I feel that this is true of my experience – I knew my grandmother was in hospital because she was ill; however I did not understand the seriousness of her illness, or that she had been in hospital for a considerable length.
Children from five to ten years of age develop an understanding of death as an irreversible process (Currier et al, 2008). Concrete thinking is seen in children until the age of 10, and need concrete expressions such as pictures or visiting graves or memorials as support for their grief (Currier et al, 2008). When my grandmother died, I knew that it was an irreversible event. My parents chose not to take me to the funeral, which I feel was a wise decision. I believe that although I knew my grandmother had died and that this was not a reversible event, I would have found it distressing to see my parents and other adults so openly upset. Research has also found that if children do attend funerals, it should be with someone who can provide emotional support (Currier et al, 2008), and I feel that this would have been an unfair demand on my parents at the funeral, particularly as I was so young.
As I grew older I found that accompanying my parents to the graves of my grandparents, particularly my grandmother, helped me to express my feelings and to ask questions. This is supported by literature which states that visiting graves or memorials can offer children or young adolescents a channel for communicating about the deceased person, which can help them to understand the circumstances of the loss and can also act as an opportunity to express their feelings (Paris et al, 2009). I found that as I matured, I could talk about my grandparents away from their graves, as I came to realise that this would not upset my parents. As a result of this, we were able to talk much more freely and openly about their lives.
My grandmother was the only grandparent that I had known, as my other grandparents had died before I was born. As my grandmother had died when I was relatively young, I have no substantial memories of her. Throughout my childhood this did not have a large impact on my beliefs and attitudes, as I believe that I did not possess the emotional maturity to reflect on the changes this had made to my life, and the impact that her death may have had on those around me. As I grew older, I became aware of the effects of loss on those around me, and in turn this altered my beliefs about life. For example, as I matured I became aware that death can happen at any age and so I was more appreciative of the roles that relatives and friends played in my life, and did not take their presence for granted.
This changed when I was at secondary school and I came to appreciate the roles and relationships that grandparents had in the lives of my peers. I felt, and still feel, that I have missed out on these key relationships, particularly as my parents often comment on how similar I am in both personality and appearance to my grandmother on my mother’s side. As I grew older, particularly in adolescence, I came to value relationships with relatives and friends in a different way from childhood, and I think that experiencing loss early in life was a large part of this. I believe that it is important to work hard to overcome obstacles to maintaining relationships, such as geographical distance and cultural differences, particularly as there is now greater mobility for employment.
In conclusion, although the death of my grandmother was perhaps not a shock to the adults in my life, I had not grasped how ill she was, nor had it been explained to me by adults close to me. As a result of this, I felt guilty because I had not chosen to visit her in the hospital when offered the opportunity. However as we had always lived quite far apart, there was no real impact on my daily life, which research has shown to be particularly disruptive for children going through grief (Bonanno, 2004).
There is clear evidence that experiencing death, particularly a traumatic death, can have a profound effect on childhood, and that a well-established support system is key (Brown et al, 2008). I believe that I had a well-established support system, and this allowed me to adapt to life without my grandmother without great levels of difficulty. Whilst I wish I could have had a longer relationship with my grandmother and have known my other grandparents, I believe it is important not to dwell on things that cannot be changed. Instead I invest my energy in building and maintaining relationships with friends and family. I believe that this attitude comes with maturity and experience of loss, and that small children may not have the emotional capacity to understand this.
Bonanno, G. (2004). Loss, trauma, and human resilience: have we underestimated the human capacity to thrive after extremely aversive events? American Psychologist, 59(1), pp.20-28.
Brown, E., Amaya-Jackson, L., Cohen, J., Handel, S., Zatta, E. (2008). Childhood traumatic grief: a multi-empirical examination of the construct and its correlates. Death Studies, 32(10), pp.323-326.
Cohen, J. 2011. Supporting children with traumatic grief: what educators need to know. Developmental and Educational Psychology, 32(2), pp. 117 – 131.
Crenshaw, D. 2005. Clinical tools to facilitate treatment of childhood traumatic grief. Journal of Death and Dying, 51(3), pp.239-255.
Currier, J., Neimeyer, R., Berman, J. (2008). The effectiveness of psychotherapeutic interventions for bereaved persons: A comprehensive quantitative review. Psychological Bulletin, 134(5), pp. 648-661.
Dowdney, L. (2008). Children bereaved by parent or sibling death. Psychiatry, 7(6), pp.270-275.
Himebauch, A., Arnold, R., May, C. (2008). Grief in children and developmental concepts of death. Journal of Palliative Medicine, 11(2), pp.242-244.
McClatchy, I., Vonk, E., Palardy, G. (2009). The prevalence of childhood traumatic grief – a comparison of violent/sudden and expected loss. Journal of Death and Dying, 59(4), pp.305-323.
Melhern, N., Porta, G., Shamseddeen, W., Walker, M., Brent, D. (2011). Grief in children and adolescents bereaved by sudden parental death. Archives of General Psychiatry, 68(9), pp.911-919.
Paris, M., Carter, B., Day, S., Armsworth, M. (2009). Greif and trauma in children after the death of a sibling. Journal of Child and Adolescent Trauma, 2(2), pp.71-80.
Piaget, J. (2013). The Construction of Reality in the Child. 3rd ed. London: Routledge.
Salloum, A. (2008). Evaluation of individual and group grief and trauma interventions for children post-disaster. Journal of Clinical Child and Adolescent Psychology, 37(3), pp. 495-507.
Shear, K., and Shair, H. (2005). Attachment, loss, and complicated grief. Developmental Psychobiology, 47(3), pp.253-267.