Medium 9781855751743

Death Talk

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This book tackles head on the often tabooed subject of death. It distils sophisticated clinical work into simple language, and describes simple techniques for talking to children about dying. The author makes sophisticated material accessible to a much wider range of practitioners than trained therapists.

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9 Chapters

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Chapter One - To Talk or Not to Talk

ePub

CHAPTER ONE

To talk or not to talk

Why talk?

Books on death and dying commonly emphasize the necessity for families of the dying to talk about the impending death with each other. Advice is given to families and professionals to talk openly with the dying rather than indulge in a “mutual pretence” that he or she is not going to die. It is commonly suggested that this “mutual pretence” is associated with a poor dying outcome—for example, a painful or unhappy death for the dying person, in some cases involving a physical or emotional struggle. People who are able to talk openly and freely about their death are deemed more likely to have a “peaceful” death. Links are also made between the bereaved person's failure to talk about the death, his or her “denial” of the loss, and a poor prognosis for resolution of the grieving process. Experts in the field argue that a satisfactory resolution of bereavement involves “working through” the loss, which requires talking about it in order to “make the loss real”, “saying goodbye” to the deceased, “letting go”, and thereby being able to “move on” (Worden, 1991).

 

Chapter Two - Beyond a Mature Concept of Death

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CHAPTER TWO

Beyond a mature concept of death

Thirteen-year-old Margaret told the hospital play specialist that her cousin Virginia had said that she had only three days left to live.

Four-year-old Dina had two imaginary friends, Skimpy and Squonk, who went with her everywhere. As she helped Squonk into the car one day, Dina informed her mother that Skimpy had died.

These two children were suffering with life-threatening illnesses for which no cure was deemed possible. Their announcements occurred around the time the medical team had decided to stop active treatment and to transfer the child to palliative care. Children often discover their prognosis through their reading of the context and non-verbal communication, which includes the interpretations they make of others' behaviour or of the roles of specific hospital staff and procedures. Margaret probably gleaned a lot of information about her health status from eavesdropping on adult conversations. Dina's awareness of death was probably influenced by the contact that she had with other patients who were dying (Bluebond-Langner, 1978; Kendrick, Culling, Oakhill, & Mott, 1987). Usually the child initiates the conversation about death, perhaps in an attempt to establish who knows what, who is open to talk or tell, and whether it is acceptable to talk about death in this relationship. The child may also be conveying messages like, “I am aware of death, I know I am going to die, can you talk about it, can you manage it?”

 

Chapter Three - Getting It Right

ePub

CHAPTER THREE

Getting it right

The perfect death

Mrs H repeatedly referred to her memory of the day that her 6-year-old son Georgie died. She sobbed when she pictured his final breath and what she described as the “fit” that preceded it. Several times she drew for me a powerful image of how “his eyes rolled back in his head, he twitched and shook and went dead and staring, pale and milky…his mouth wide open, his eyes glazed”. She wept that Georgie had not died peacefully, had not “just floated away…why did he have to struggle like that?”

Dying is not always a beautiful affair, and how people die can remain with the memories of the people who live on. The effects of these memories can differ, depending on the theories that the bereaved use to make sense of the episode of death. Beginning with the theory that a good death is a peaceful death, a pain-free death, involving open communication between all family members and honest preparation of the child, Mrs H could only lament the lost opportunity for such a perfect death and criticize herself for not doing the right things to enable it. Feeling a failure that she had not helped her son to have a peaceful and easy death, she experienced his death in terms of a “fit” and a “struggle”, which she attributed to her refusal to heed the advice she was given to “let go” and to her difficulty with managing his pain control.

 

Chapter Four - Creating New Stories

ePub

CHAPTER FOUR

Creating new stories

Alan described how he and his children would make up stories together at bedtime. Recently, 4-year-old Ron had been “introducing death into the stories”; 2-year-old Sarah “would always add a princess or two”. Alan acknowledged with amusement his attempts to “sugar the pill”. Each time Ron “killed off a character”, Alan would find more inventive ways of bringing that person back to life with “reviving drinks, reversal spells—you name it”.

In order to make sense of our lives, we organize our experiences of events, thoughts, and feelings into coherent accounts in a way that such narratives can give meaning to our experiences. These stories can create for us a sense of continuity in our lives and provide a framework for interpreting further experiences. Therefore we live our lives according to those stories that we tell ourselves and those that we are told by others. Our stories shape our lives, influencing which experiences we pay attention to, give meaning to, and continue to incorporate into our constantly evolving narratives (White & Epston, 1990).

 

Chapter Five - Creating Memories Towards “Co-Memorating”

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CHAPTER FIVE

Creating memories towards “co-memorating”

David (aged 12), Joanna (aged 8), and Martin (aged 5) all sobbed when they spoke of their grandmother's death. Mrs E reported that the family had “not been ourselves since nan died”. Mr E reported that he and his wife had attended the cremation, but it had been “pointless—we made nothing of it. Odd to have something where my mum did not take part. She was always part of everything we did in our family—Sunday lunch, birthdays…David came along, but we could see no point in bringing the little ones—it meant nothing to us. Nothing special—not like she was.”

Some people come for help lamenting that they have no ideas at all about what to do at times of loss and bereavement and seek a prescribed format to guide their action. For the E family, the actions and events available for mourning at the time of their grandmother's death seemed hollow, lacking the special meanings that they associated with her. Mr E complained that the cremation ceremony disconnected them from a sense of her presence, which he saw as essential to the occasion. Therefore the event offered family members no genuine sense of healing. For others the dilemma is not so much how to act, but rather how to negotiate a way to act within a context that does not open space for their preferred actions.

 

Chapter Six - Elaborating Stories and Extending Abilities: Training and Supervision

ePub

CHAPTER 6

Elaborating stories and extending abilities: training and supervision

I hold a preferred story that “death talk does not necessarily require professional expertise” and that “personal knowledges offer valuable contributions to people who are dying or bereaved”. Hence during learning events on death and bereavement, I do not choose to position myself as holding superior or exclusive knowledges on these subjects. To do this might imply that I am informing less knowledgeable participants on loss, grief and mourning and might risk subjugating their personal, cultural or religious knowledges at the outset. Instead, I prefer to share the responsibility for knowing about death, mourning, and grieving among those who participate out of an interest in learning, which includes myself. As trainer, I take responsibility for introducing new ideas from my personal and professional perspectives when possible, and for helping participants make connections between their own ideas, theories, and practice. I therefore expect to experience the training session as mutually in-forming.

 

Appendix A - Some Theories of Death and Mourning

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APPENDIX A

Some theories of death and mourning

Developmental theories

Developmental theories of children's understanding of death commonly include the idea that a person's concept of death can be more or less complete and that a mature concept of death necessarily involves several different components, including the perception of death as a natural process which is final, irreversible, and universal. The conceptual underpinning of these theories has most frequently been Piagetian (1958), and researchers have sought to delineate ages and stages at which children acquire key components, with a view to establishing the age at which to expect full development of the concept. Kane (1979), for example, identified nine components of the death concept with ages at which they emerge. She reported that children between the ages of 3 and 5 years have a basic realization of the separation involved in death as well as the immobility of the dead person, although immobility may be seen as only partial and temporary. By 6 years, the child comprehends the irrevocability of death, has a notion that death induces dysfunctionality, and is beginning to make sense of the causality of death; by 7 years, the child recognizes the universality of death. Although, by 8 years children acknowledge the insensitivity of the dead person, according to Kane it is only by the age of 12 that they fully comprehend the effects of death on appearance.

 

Appendix B - Books for Children and Young People

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Appendix C - Children and Families Cross-Referenced

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APPENDIX C

Children and families cross-referenced

Georgie H

CHAPTER 1: 6–7, 12   CHAPTER 3: 39–40   CHAPTER 4: 64–66

Georgie was diagnosed with a malignant brain tumour when he was 3 years old. Following surgery, chemotherapy, and radiotherapy, he enjoyed two years of good health before a sudden regrowth of the tumour. Progress and spread of the cancer halted Georgie's education only three months after he started attending school. He died shortly after his sixth birthday, and his mother sought help for her concerns about the effects of Georgie's death on his 3-year-old sister, Lisa.

Daniel and Benjamin T

CHAPTER 1: 7–8   CHAPTER 4: 61, 62, 63, 66–71, 74–76   CONCLUSION: 123

Mrs T and her 9-year-old twin boys, Daniel and Benjamin, met with me following the death of the boys' father. Mr T had died unexpectedly five months previously while the boys were away at boarding school. The family's doctor had requested help for Daniel, who “was talking incessantly to his father throughout the night”. Mrs T had started attending spiritualist meetings after her husband's death.

 

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