Bereavement is tough enough for adults, but for children . . .
A death can have a profound effect on a child. Different deaths need different strategies
Premature and sudden deaths, particularly of a parent, sibling or close friend, are bound to have a massive effect; homicide and suicide even more so
Some children in Dublin’s north inner city started playing a new game last year.
They called it Regency Hotel.
“They were planning what weapons they would use and how they would target someone,” Frank Mulville of the Young People at Risk Initiative told a recent conference. That’s what children do – they process what they see and hear through play. “It’s a way of coping.”
It was at the Regency Hotel in north Dublin that gunmen stormed a weigh-in ahead of a boxing match in February 2016, killing one man and seriously injuring two others. This attack, believed to be in revenge for the shooting dead of drug dealer Gary Hutch in Spain the previous September, has been followed by nearly a dozen more killings in the continuing Kinahan-Hutch feud.
As shootings kept happening, children in the north inner city lived with a constant sense that adult males in their family could be killed, Mulville told a seminar on the theme “Supporting Children in Families Bereaved through Homicide”, held as part of Bereaved Children’s Awareness Week.
Symbols of the deadly feud – funerals, checkpoints manned by gardaí with submachine guns, the folklore – continue in their midst too.
In what is a relatively small area, where people are linked through blood, work and neighbourhood, nobody has been immune from a sense of loss or worry, he said, and it’s “appallingly sad” that children have had to live with this too. Talking about it has not always been encouraged at children’s services, where workers from the community are fearful themselves, unsure of whose allegiances lie where.
Social agencies working in the area have been looking at how to support families in coping with fallout from the violence. One initiative was the production of a card with advice on how to talk to children about it.
Their concern also led to an invitation by the Irish Childhood Bereavement Network to Prof Atle Dyregrov, a Norwegian expert in grief psychology, to lead a seminar for frontline staff. A clinical psychologist, he is director of the Center for Crisis Psychology in Bergen, which he co-founded in 1988.
In the natural order of life, if a child experiences a close bereavement it is the death of a grandparent for which, it is hoped, there has been time to prepare. Some 28 per cent of children in Ireland have lost a grandparent by the age of nine.
But premature and sudden deaths, particularly of a parent, sibling or close friend, are bound to have a profound effect; homicide and suicide even more so.
“We need to see how different deaths need different types of intervention,” says Dyregrov in an interview before the seminar. “Very often with sudden death you have a combination of trauma and loss. Loss, or longing for the dead one, is a natural reaction, but having gruesome images, or fantasies of what happened is not natural.”
Trauma and loss
Trauma and loss are two distinct but intertwined aspects. “You have to deal with the trauma first. If every time you think of the lost one, the images of how it happened come up, it will be a block to the grief.”
How children react to traumatic bereavement will also depend very much on their stage of development. Pre-school children, for instance, are very dependent on adults’ reactions.
“They may not take in so much and understand so much but they are very sensitive to how the adult world around them is.” However, we should not underestimate what they will remember.
Dyregrov recalls the case of a boy who was just 2½ when his father killed his baby brother. At the age of six, although he had never talked about it, he was re-enacting in the playroom the turning over of a pram and kicking of a baby. It was obvious he had a factual memory of it, even if he was too young to have the language to convey it.
By school age, children are beginning to understand that death is final, but they don’t yet see the long-term consequences of a bereavement. “By the time they get to adolescence they see that, they understand that this is for ever – for example: ‘Mother won’t be there when I have kids.’
Sense of guilt
“It is worse for different reasons at different ages, it’s hard to compare them,” continues Dyregrov. Very young children will be affected more by the non-presence of a dead mother or father. Those in middle childhood have a very egocentric way of thinking so often believe the death was their fault in some way and their sense of guilt is often overlooked. “For those in adolescence, it happens when your emotions are most intense. So there are different risk factors at different ages.”
The tendency for the death of a parent during childhood to have a negative impact on health and educational attainment has been highlighted in research.
Dyregrov refers to a yet-to-be-published study from Denmark showing that while at the end of primary school level there is not much difference in performance between children who have lost a parent and those who haven’t, a gap starts to appear at second-level and they are significantly less likely to get a university degree.
While this discrepancy would be partly due to life circumstances, failure of bereaved children to fulfil their potential is also down to how grieving can affect concentration and memory. He has worked with schools in trying to improve support, not only in the immediate aftermath of a death but also in the long term. Teachers haven’t really addressed, he suggests, how best to deal with bereaved pupils whose mental capabilities have been affected.
The lack of long-term support – both in public services and within social networks – is a recurring complaint among families he has surveyed in the wake of traumatic bereavement.
I joke that teachers only have 20 minutes’ memory
“We see it in schools. I joke that teachers only have 20 minutes’ memory. It is natural or human that we don’t think what people have gone through when we meet them but for those who have lost their parent, or both parents sometimes, it is hard.”
The return to school needs to be planned, in a consultation between the child, family and school. For example, does the child want to talk about the death to classmates on the first day back or should the class be briefed in his or her absence?
Pupils complain that while one teacher may be very understanding, another is not. He says all teachers dealing with a bereaved child need to agree a similar approach, which should be tailored to the needs and desires of the individual.
While some may want to talk about their loss and have it acknowledged frequently, others might see school as an escape from the grieving at home.
He remembers a 16-year-old girl whose sister had been murdered and he was doing follow-up work with the family. One day she came in and told Dyregrov: “You need to talk to my teacher – she has been on a course with you and I don’t want her to every day ask me, ‘how are you doing today?’”
“It put her on the spot and she didn’t want to talk about it,” he says.
Routine and normality for children is very important. “Even the same day the parent dies, the child needs the same structures – so you sing the same songs at bedtime. The reason for this of course is that when things get chaotic, you need a structure and familiarity of doing the things that you usually do.”
It calms children and gives them a sense of safety. He doesn’t think it is wise to delay the return to school beyond a week or two, as that is likely to cause problems later.
“You can work and grieve – adults do it, children can do it. But,” he stresses, “you can’t do it in a system where there is no recognition or understanding.”
Bereavement through homicide is rare for children but it so much more difficult to cope with – particularly as it often involves one parent, usually the father, killing the other, and the child may have witnessed it.
This means the child suffers trauma and a double loss – one parent dead, the other imprisoned. They are likely to have to go and live with relatives or a foster family – moving them away from their home and possibly from their friends and neighbourhood as well.
Right from the start, services such as the police and hospitals, have to be thinking about the impact of a death on a child.
The important thing is that children are included in the information and that we are open and honest with them”
“When it comes to breaking the news, there is a thin line between what is therapeutic and what is traumatic,” says Dyregrov. For instance, it must be made very clear early on whose death is being talked about, in case they start thinking it is someone else.
“The important thing is that children are included in the information and that we are open and honest with them.”
They should not be excluded from seeing the body, if that’s what they want, and they should continue to be updated on new information about the death.
Scene of disaster
Dyregrov, who has worked at the scene of many disasters, says facts are important to children, as they are to adults. When people are awaiting information, they are very tense but when you start giving them facts about a situation, it calms them.
They also need to know what’s normal in the grieving process so they don’t think they are going crazy. Coping with death will be helped by a “combination of the facts and having a map of the terrain you are walking into”, he explains.
Later, at the seminar, he shows a remarkable series of drawings by a 12-year-old boy who was coping with the trauma and grief of his father being killed in a fight with another man on the way home from a pub one night.
The first drawings depict a knife and the killer with his head cut off; in the next, his right hand has been severed. These are “revenge fantasises”, Dyregrov explains, and they are “not dangerous”.
Then the boy tries to work out why his father might have come off worse in the fight, drawing him in the tussle with his glasses falling off. There’s a drawing of a stone, which was the weapon used on his father, who was left injured and froze to death. Later, drawings depict his father up in the sky and the boy below, and then the two of them reunited.
“He draws the trauma and then he draws the grief,” says Dyregrov.
Support within family and community is enough for most bereaved children and only a minority will need organised bereavement services or professional counselling, fewer again very specialist mental health services. However, the capabilities of a parent will be diminished by their own grief, so they need help in this area, and the social network may be well meaning but unsure of what to do.
“Often the worst period for a family is not the first weeks, it is when every day the reality comes back and all the services are not there,” says Dyregrov, who had never imagined that he would be working on crisis intervention after a mass killing in his own country.
On July 22nd, 2011, 77 people were killed in two attacks by right-wing extremist Anders Behring Breivik, who left a car bomb in Oslo before shooting dead 68 people attending a youth summer camp on the island of Utøya.
Some of what Dyregrov and colleagues learnt from working in the aftermath of that, and continue to learn through follow-up studies on both survivors and the bereaved, has been used to advise other communities struggling to cope with their own atrocities or disasters, such as the Manchester Arena bombing and the Grenfell Tower fire.
There’s a need for persistent offers of help in the long-term, both by services and the community. “People say, ‘when I said no the first, second and third time, they should have asked a fourth,’” he reports.
Afraid to talk
It is also important to understand how traumatic death affects communication – both within the family and the community. People are afraid to talk about it and aspects can be kept secret.
Dyregrov stresses that “not everything is in a child’s head – it is the interaction in society that might be the problem”. He gives the example of a boy whose brother committed suicide and one year later he is greatly troubled that his friends never ask him about his brother. “He is utterly alone. His loneliness is not an individual problem – it is created by those around him.”
One remedy is for the school nurse to work with his friends on how to talk to him.
More needs to be done on mobilising social support, which studies across the world show is so important after a bereavement, he says. Yet, sometimes when people are uncertain what to do, they pull back.
That’s why, where a parent is seriously ill, he recommends “network meetings” of family and friends in the children’s school or home, to find out what support the family wants and what people can provide. Almost like in a hospital, he adds, there needs to be a rota of people taking turns to offer help after the death, so the support goes on longer than it normally does and helps to improve the life quality of the children.
Meanwhile, back in north inner-city Dublin, the one question children who have witnessed a shooting or its aftermath keep asking, reported Mulville, is, “will it happen again?”
Unfortunately, nobody in the community can give them the assurance it will not.
By the age of nine, among children in Ireland:
28% have lost a grandparent
7% have lost an aunt or uncle
6% have lost a close friend
2.2% have lost a parent
1.1% have lost a sibling
Source: The Irish Childhood Bereavement Network