When Students Encounter Death
This article begins with an overview Jean Piaget's Stages of Cognitive Development, as this model can be used to identify corresponding implications related to death and bereavement in the developing child. The article also delves into the experience of death that a student may encounter, in terms of the impending death that he or she may face due to terminal illness, as well as the sudden or expected death of a close family member such as a parent or sibling. Treatment and support methods are also discussed.
Keywords: Concrete Operational Stage; Death & Dying; Disability Stress Coping Model; Formal Operational Stage; Grief; Mourning; Preoperational Stage; Sensorimotor Stage; Transactional Stress & Coping Model
A Cognitive Understanding of Death
Jean Piaget was a pivotal developmental theorist who greatly contributed to our understanding of how children think and behave during their physiological, emotional, and intellectual maturation (Chandler, 2009; Pramling, 2006). Although Piaget's emphasis did not surround a child's interaction with death directly, his model can nevertheless cast light onto how children conceptualize life's finale. Well-intentioned adults often presume that children grieve in a similar fashion as they do, and are surprised when little Johnny and Suzie begin to play during grandma's funeral, never shedding a tear. The opposite extreme is when adults completely shield children from the reality of death by talking in hushed tones in their presence and sparing them the details surrounding funeral services and other ritualistic procedures. Western culture is reticent about facing the tribulations that naturally accompany death, and so caretakers awkwardly stumble when faced with such a heart-wrenching topic. The following is an overview of Piaget's theory of infant and childhood cognitive development, which comprises a series of stages surrounding the various impressions that youngsters cogitate in order to understand the world around them. Each subsequent stage converts into a more sophisticated train of thought through a process called equilibration (Cohen & Kim, 1999; Ferreiro, 2001). Imbedded within the description of each stage is an extrapolation of how children might developmentally respond when informed of terminal illness and/or death of a loved one.
Piaget's Theory of Cognitive Development
The Sensorimotor Stage
The Sensorimotor Stage takes place during the first two years of life, and is marked by rudimentary abilities that lay the groundwork for future behavior that requires a hybrid of physiological and cognitive cross-sectioning (Williams, 1996). This stage initially is characterized by the infant's ability to utilize reflexes such as sucking, primary, secondary, and tertiary circular reactions which take place when the infant first maneuvers his own body (e.g., puts his thumb in his mouth). This behavior is followed by the manipulation of outside objects with his body (e.g., knocking the pacifier out of his mouth). More pertinent to the theme of death, dying, and bereavement, the offset of the Sensorimotor Stage is portrayed by the toddler's interaction with surrounding symbols-words, images, and behaviors that represent what is going on inside of his mind and/or emotions that he is feeling.
For example, upon stubbing his toe, he might equate the word "ouch" with his predicament or screech for "mommy" as the figure who will alleviate his pain. Although the layperson may operate under the faulty notion that children in this stage do not notice the death of a parent, this belief mistakenly does not acknowledge that that the child has internalized the "mother" and "father" symbols as those who devotedly tend to their needs, feed them, and pacify their discomforts. Although young infants do not intellectualize these roles in a mature fashion, they respond to uprooted schedules that would naturally accompany a parent's death, as well as the sadness that the remaining parent experiences that makes him or her withdrawn and less attentive to the baby's needs. Both Freud (Tyson & Tyson, 1993) and Mahler (Straussner & Spiegel, 1996) pointed out the existence of object constancy, or an infant's growing bond with various objects in his life, including the "mother object," for which he cannot tolerate a "replacement" mother. The importance of the caretaker-infant bond, and the devastating effects of an absence of such a rapport has been corroborated by theorists such as Belsky and Bowlby (Belsky & Campbell, 1996).
The Preoperational Stage
The Preoperational Stage occurs from 18 months to six years of age (about preschool — 1st grade), when children's utilization of symbols becomes both more advanced and more pervasive to other life arenas, including play (Holbrook, 1992). For example, a 2 year old boy might use an ordinary sitting stool to fulfill a variety of imaginary capacities by pretending that it is a motorcycle, a mountain, or a raft. This lends itself to another common Preoperational Stage tendency, that of magical, fantastical thinking. Children at this age have great imaginations which they use to concoct whimsical, mystical truths that help them elucidate their surroundings. For example, Preoperational children commonly become excited at the notion of fairies, Santa Claus, and other fictitious characters that possess supernatural, immortal traits, and they consequently assign these characteristics to humans as well. When people die, Preoperational children might believe that a resurrection will take place, similar to cartoon characters who, upon meeting with catastrophic tragedies such as falling from sky scrapers, pick themselves up and resume their activities. Preoperational children, therefore, may wonder how a buried relative will be able to eat dinner, or if cremation is painful. They also may grieve inappropriately (by adult standards) by playing and keeping with their normal routines, experiencing only brief bouts of sadness.
Another hallmark of Preoperational thinking is egocentricity (Macaskill, 1982). Children believe that everybody's experiences and perspectives match their own. For example, if a little girl looks out of the window in her rural neighborhood and sees trees, grass, and other forms of nature, it is difficult for her to conceptualize that others people have other surroundings such as a bustling urban center or a suburban cul-de-sac. In terms of their ability to reason, children at this stage engage in what Piaget called transductive reasoning, such as when they observe two situations simultaneously occurring, they automatically believe that one is the cause of the other. A child that employs this logic might notice that the family normally takes a fun trip on summer vacations. When the family takes a trip in the spring, he or she erroneously concludes that it must be summertime. The combination of egocentricity and transductive reasoning makes it common for children to assume responsibility for the deaths that affect their lives. Thus, a little girl whose father passed away might believe that she killed him based on her naughty behavior.
The Concrete Operational Stage
The Concrete Operational Stage occurs with children between the ages of six and 12 years; roughly grades 1st to 6th. Children in this stage are able to contemplate the notion of reversibility, or the ability to overturn a person's deeds and thoughts (Docherty, 1977). Bereaved Concrete Operational children are able to grasp the irreversibility of death, which is a huge milestone that is absent in the Preoperational Stage. Hence, when parents describe that Uncle Bob has "gone to sleep for a very long time," children in this age cohort do not hold fallacious expectations that he will eventually awaken. Also, Concrete Operational children are able to rationalize about their lives inductively, although they still struggle to think deductively, which requires more abstract analyses. For example, a child may inductively infer that if you leave a glass full of ice cubes outside of the freezer, they will melt and convert into liquid form. However, he may struggle to deduce broad principles that have yet to personally materialize, such as the implications of global warming. Therefore, the Concrete Operational child may not be able to enter into the abstract realm of after-life issues that have perplexed humankind since the dawn of existence, but instead unquestioningly and simplistically regurgitate the beliefs that his parents/community/society holds. Or, these children may focus on concepts that have concrete answers to satisfy them, such as those that pertain to the human body, which may be a source of contention for parents who are alarmed by their child's sudden obsession with corpses.
The Formal Operational Stage
The Formal Operational Stage (Commons, Richards, & Kuhn, 1982; Day, 1981; Kuhn, 2008) begins once the child turns 12 years old, and continues throughout the length of adolescence; about 7th grade to college. During this period, teenagers refine their ability for deductive reasoning. This ability transcends into the death and dying sphere, as they are now able to contemplate the emotional complexities associated with a loved one's demise, and are in touch with their own feelings of sadness, loneliness, and fear. However, they may turn to friends instead of their families for a sense of solace, which may exclude parents. This tendency is developmentally appropriate, as teenagers naturally break away from parents and gravitate toward same-age peers in order to develop a sense of autonomy and clarify goals and values that are distinct from that with which they were raised.
Another basis for disagreement between parents and teenagers is that in response to the loss, the latter may deny their own mortality through risky behaviors. A mother may become perplexed that her teenage son picks up smoking upon the death of his father from lung cancer, or that her daughter starts to drive recklessly in the aftermath of her sister's fatal car crash. Although there is much turbulence that accompanies both adolescence and a death in a family, optimistically speaking, mature adolescents are able to hone an aptitude for systematic, methodical problem solving, and are also able to look toward their future and strategize a shift of roles, priorities, or financial cutbacks their family may eventually undertake because of the death.
Terminal Illness in Children: Coping Models
Although people logically recognize that humans can die anytime, they hold an unconscious expectation that youth is abiding and that people succumb to death during their golden years. Thus, the experience of childhood terminal illness, for both the dying child and his loved ones is perplexing, unjust, and tragic. The Transactional Stress and Coping Model, or TSC (Hocking & Lochman, 2005) and The Disability Stress coping Model, or DSC (Guamundsdottir, Guamundsdottir, & Elklit, 2006) address how youngsters handle their terminal illnesses (Brown, Daly, & Rickel, 2007).
The Transactional Stress
The TSC model incorporates three key mechanisms that enable the degree to which children psychologically manage their conditions. The first component involves the cognitions that are experienced by parents and children alike. Cognitions are the cerebral thought processes that guide our emotional wellbeing and behaviors, and include positive and/or negative self-talk, expectations, assessment of circumstances, and confidence. As opposed to associating positive cognitions as those which are superior and negative cognitions as those which are destructive, it is more appropriate to view cognitions as realistic or unrealistic. For example, a child whose malignant brain tumor renders a poor prognosis may have parents that possess an overly optimistic view which can yield a devastating outcome when the child does not recuperate as anticipated.
The second component of the TSC model describes the ways children and parents cope with the terminal illness, or the action-oriented responses that are elicited by cognitions. For example, parents who...
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