In my last post I wrote about my daughter’s recent (many!) questions about death, and how I wanted to know more about how to answer her questions other than to say, “I don’t know.” So I invited grief counselor and former hospice minister Joseph Primo on the blog to give me some advice on that—and also to tell us how he talks to children when they’ve lost a loved one. Joseph is the CEO of Good Grief, an organization in New Jersey that helps normalize grief and loss for children and teenagers. He is also the author of What Do We Tell the Children?: Talking to Kids About Death & Dying. See my Q&A with Joseph below, including his list of ways he’d prefer/not prefer to die. (Really.)
Our latest podcast episode is about a young man whose sister died the same day she was born when he was 4 years old. He says that his entire worldview was impacted by constantly wondering how his life would’ve been different if his sister had lived. In your experience, how do siblings uniquely internalize loss? And how does a lifetime of internalizing loss manifest in adulthood?
Joseph: When people say children do not grieve they are misinformed. Kids are affected by their grief and their parents’ grief, especially when the latter permeates a household through sadness or silence. It is not uncommon for a child to grieve a sibling they never met, to desire the ability to talk openly about a sibling but be forbidden or scared to do so, so as not to upset a parent, and to imagine how life would have turned out differently. The death of a family member inherently changes a family’s dynamic and perception of itself. A child’s grief does not have to be limited to the death of the person. It can include grieving the role that person played or the potentiality of having a sibling and how that brother or sister would have changed their relationship with their parents, their teen and adult years, and all the elements of a family’s evolution—real or imagined.
Often, when young children lose a brother or sister, they have never actually met that sibling. How do you counsel young children on the loss of a family member that they have never met?
Joseph: My mom had a very late miscarriage. She was pregnant with a boy and did not tell me he died. Shortly thereafter, my sister was born. Not having a good sense of time, I was confused that she was not a he. I was quite upset and my sister got the brunt of those feelings. Every child responds differently. It is crucial that those differences are acknowledged, affirmed, and given a space to be processed in a meaningful way. When I meet a child who did not meet or does not remember a sibling who died, I want to understand what’s it like for them not having that person in their life. How would their life have been impacted both positively and perhaps negatively? How has the death changed their understanding of themselves and their family, especially their parents and that relationship? Supporting a grieving child is never about fixing the pain or even making them feel better. It’s about self-awareness, coping skills, and coming to terms with a life that is, rather than what it may or may not have been. I trust a child’s process and help facilitating their experience by listening and learning their story, as they see it.
When young children lose a grandparent, they often become afraid that their own parents will die. How can we assure our children that we are there for them, while knowing in the back of our minds that accidents do happen sometimes?
Joseph: Children do not grow up saying, “Hey, mom, thanks for lying. That was super helpful.” Being honest is really important. I work with kids who have had a parent or sibling die. They know and understand big and scary things can happen to those they love. Honesty and openness provide a child with the opportunity to process their fears so that a child, who may become clingy because they don’t want their mommy to die like daddy died, can develop coping skills for life. When children are given the space to talk about their fears, parents are often surprised to hear that the child is worried about their needs getting met, keeping their routines, and having access to the things they enjoy. Their fears are not always about the parent dying, but their lives being disrupted in a way they can’t imagine.
Many children first encounter death with the loss of a pet. I think a lot of parents are tempted to tell a white lie, and say that the pet “fell asleep” — or even to replace a fish overnight, hoping that the child will not notice. How do you recommend parents speak to their young children when a pet dies? And is there a way in which we can see it as an opportunity to become closer, rather than an impossibly scary conversation?
Joseph: The death of pets is accompanied by emotions. We grieve our pets, especially intimate relationships with pets like dogs and cats. Rather than pretend death is scary and that we need to keep this very obvious reality a secret, I encourage people to be helpful. Is it helpful to say, “Buddy went to sleep?” No. There is a good chance that child will be scared to go to sleep because she’ll equate sleep with going away forever or death. Instead, we can help a child develop coping skills that will serve them when a human dies. The death of a pet is a learning opportunity, as are all difficult things in life. These things can lead to healthy coping and positive outcomes after something we cannot control. So, instead, I encourage parents to explain death in real, biological terms in age appropriate ways. Talk about how the body works, how our organs (just like parts on a toy) break, and how when our bodies don’t work we die. Then talk about how living bodies are different from dead bodies. While that might sound scary or morbid to an American adult (as adults we’ve grown accustomed to not talking about these things which makes us uncomfortable and unprepared), a child will be curious and have a lot of questions. They’ll be busy learning, exploring, and processing.
My daughter has no direct experience with death, but she is obsessed with talking about it. She is four-and-a-half, and almost every day for the last few weeks she has been asking me questions like, How old are you when you die? When are you going to die? When am I going to die? When people die, do they become houses? Are there soldiers near us and if they shoot us, will we die? And sometimes she just breaks down crying because she doesn’t want to die ever, ever, ever. What kind of anxiety level over death is considered normal in a kid who hasn’t encountered loss? And how can I answer these kinds of questions to ease her anxiety?
Joseph: Children are exposed to death in all sorts of ways: Disney movies, games, television, folktales, peers, etc. As children are hearing about death they are processing it. That processing is impacted by their developmental growth and it will change as they mature. What’s normal? Well, I don’t want to die. I get anxious about it sometimes. I wonder where and how death will come for me. Geesh, I even have a list or preferable vs. unpreferable ways to die*. And I deal with death every day. I think it is so important, as adults, that we ask ourselves if we want to be helpful to a child’s process and learning or do we want to get in the way with responses that do not build healthy coping. This is a prime opportunity for your daughter to learn about death, it’s uncertainty, and how many of us live long and good lives. It is important to say that sometimes death surprises us, but when it does there are lots of people who care for us and love us, so that we’ll be okay even thought it might be a hard experience. Lastly, I think it is important for your daughter to name what she is afraid of and to give her the space to talk about death and her feelings whenever she needs to do so. Often times these conversations come up in spurts. It’s not helpful to push them, but to give them the space they need. Rather than trying to find a “right” way to respond, create a dialogue, provide honest responses, admit what you don’t know, and offer realistic assurance where you can.
*Joseph’s preferable vs. unpreferable ways to die:
I’m open to it
Stage IV something (I like the idea of saying goodbye and experiencing “lasts”)
Something foolishly heroic that would have had a different outcome if I wasn’t trying to be heroic (I’m not even a great connoisseur of irony).
82 years old and my heart gives out while walking in a park or listening to great music (the ideal situation)
I’d rather not
Lung Cancer (fear of suffocating)
Brain Cancer (I like to be lucid and in control)
Car accident (I want some time to say goodbye and my car isn’t tidy. I prefer to die in a clean environment)
How do YOU talk to your kids about death?
Tell us in the comments.
Photo: Henry Vega
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