«We should call death by its name»

Mrs Bobillier, you provide psychological support for children and young people in mourning. How does such counselling typically come about?

My speciality is bereavement within the nuclear family, i.e. the loss of a sibling or parent. It is usually fathers or mothers who get in touch because they are worried about whether the way their child is dealing with the death of a family member is normal. After a loss, children often display behaviour that does not correspond to the image we have of a grieving child.

What does this picture look like?

In the media, we usually see the same photos on the subject: children with their hands over their faces, staring into space with tear-filled eyes - this is the kind of grief that adults expect.

Children can be engrossed in play and suddenly be overwhelmed by their grief.

Recently, a recently widowed mother contacted me because her daughter's nursery school teacher had expressed concerns: the child was playing normally and never cried, possibly suppressing her grief. This is typical: adults have a certain idea of grief, and if children don't behave accordingly, they think something is wrong.

What distinguishes childhood grief from adult grief?

It is more lively. Children can be engrossed in play and suddenly be overwhelmed by their grief - and just as quickly resume their play. In this context, the German author Gertrud Ennulat coined the term «puddles of grief», into which children stumble and hop out again. This is a healthy way of regulating emotions.

Grieving adults also fluctuate between loss-orientated moments and those in which they turn towards life. However, children do this much more erratically, which adults often interpret as immaturity. When they see a child playing at a funeral, they think they are just too young to understand what has happened.

When does a child understand death?

Most scientific publications mention four aspects in the development of the concept of death that a child learns to understand over time. Firstly, death means complete cessation of bodily functions. Secondly, it cannot be reversed. Thirdly, all living beings must die at some point. Fourthly, the causes of death are biological. As children get older, they usually understand these four dimensions in the appropriate order.

When is a child ready?

This depends on the stage of development. On average, children start to think on an abstract level and make assumptions that go beyond their own experiences from around the age of twelve. They begin to think hypothetically. For example: All living beings must die. My mum is a human being. It follows from this: My mother must also die one day.

In this phase of life, the child realises that not only old people can die, it knows that all bodily functions end with death, that it is irreversible and biologically determined, i.e. not the result of magic. In young children, on the other hand, so-called magical thinking is very pronounced.

How does it manifest itself?

At pre-school and kindergarten age, children relate almost everything to themselves. They often think that they can influence events with their thoughts. This can lead to a child feeling responsible for a death, for example because they were once angry with the person who died. This self-centredness and magical thinking diminishes with age, but even young schoolchildren are sometimes still prone to it.

What is important in this case?

Firstly, every child who loses someone should be informed, without being asked, that they are not responsible for the death of the deceased person. Children should also be informed about the cause of death. In the case of an illness, you can explain to them that there are mild to severe illnesses, that most of them can be cured, but that very serious illnesses can also cause death.

The idea of finality can frighten children, but it also gives them a thrill.

If someone has died of cancer, for example, it is important for children to learn that this disease is not contagious and that they do not need to worry because they have visited the person who is ill. Children want to be able to assess the circumstances under which someone may die. So they sometimes ask very direct questions.

For example?

After an accidental death, a child may want to know the details: Was the person crushed in the car? Was the blood pouring out of the window? Was the arm still attached? At primary school age, around seven, many children develop a sense of time and understand that death is final. The idea of finality can stress or frighten them, but it also gives them a thrill. At this age, for example, it is typical for children to be interested in scary stories and details of a dead body.

How do adults react to such questions?

By answering matter-of-factly and calmly: «Yes, the arm was still attached. The blood was in the car and outside.» And they should call death by its name, declare a person dead or deceased, not say that they have fallen asleep or that God has taken them away. Such statements can cause difficulty falling asleep because young children fear that they might not wake up. It also helps children who do not yet understand death cognitively to approach the topic through their senses.

How, for example?

You can explain to the child: «When someone dies, it looks as if the person is asleep. But the difference is that their heart is no longer beating. It's the heart that pumps blood through the body and makes us feel warm and able to move.»

Ideally, a child is allowed to understand death literally, i.e. to touch the deceased person.

Then you can put your hand on each other's chest, feel the heartbeat - and give the child a vivid impression: We are alive, our hearts are beating, our bodies are warm and mobile. The dead, however, no longer have a heartbeat, their body is cold and cannot move. Ideally, a child should be able to understand death literally, i.e. touch the deceased person.

Parents may think that this could overwhelm their child.

By leaving them out of the process of saying goodbye, they deprive them of the opportunity to experience the death of a loved one in such a way that they can better categorise and process it in the end. This is why children should also be allowed to help organise the farewell ceremony, gravestone, coffin or urn.

Doing something for the deceased person empowers them because it makes them feel less helpless. Children usually deal with death quite naturally. If adults do not want to expose children to such experiences, they often do so - unconsciously - in order to protect themselves, as the situation is difficult for them to cope with.

In what way?

In the course of our socialisation, we have learned that death is a taboo subject. It used to be much more present in everyday life. Medical progress and individualisation have pushed death to the margins of society.

When it arrives, we are overwhelmed. Parents are already unsure how to explain the death of their grandmother to their children. If a member of the nuclear family dies, many are speechless. Suicide certainly plays a special role in this context.

How do adults find helpful words for this?

Suicide, in particular, should be explained to children - without judgement of the manner of death, for example with unobjective attempts at explanation. Adults should neither idealise suicide as «suicide» nor devalue it as «suicide», but rather speak of suicide.

How much information can a child take?

What we don't explain to children, they make up, which is usually more stressful than the reality. That's why a factual explanation is important: «Dad hung himself from a tree and died.» You should leave out grotesque details, but answer honestly what the child wants to know.

Parents should also allow their own pain and not try to spare children from it.

At the age of twelve, many children still think that people only die from obvious causes such as accidents, illness or war. They are usually not yet able to understand that a less visible condition that cannot be recognised by physical injury, such as depression, can end in death.

What can contribute to understanding?

Mental illnesses often become more tangible when explanations make a connection to the physical. For example: «Dad was seriously ill, but the illness wasn't in his body like it was in Grandad's, but in his soul. The illness is called depression and can become so severe that someone no longer feels anything good. Dad couldn't think and feel the way he used to because of his depression and therefore no longer wanted to live.»

The child should know that mental illnesses can often be cured if we confide in someone. They should learn from their parents that it is possible to talk objectively and lovingly about a person who has committed suicide, that even bad things do not have to be taboo and that dealing with them openly is helpful.

What if a child is plagued by feelings of guilt in such a situation?

Then you shouldn't explain it away, but talk about it. Blaming oneself or others is a common strategy used by mourners to explain the incomprehensible. In the case of suicide in the nuclear family, however, it is important to clarify the suicidal behaviour of the surviving family members. Certain behaviours that are considered signs of increased suicidal tendencies - such as the expressed desire to die - can also be an expression of grief that is temporarily completely normal. A specialist can categorise this.

Is therapy generally advisable for grieving children?

Many get along well without them. But they are dependent on empathetic carers. Many behaviours that worry adults are initially normal after a loss. Frequent crying or not crying at all, outbursts of anger, aggressive behaviour, withdrawal, concentration problems, separation anxiety, self-doubt or wetting themselves at night: Grief reactions are varied, as are the feelings associated with them. Children should also be aware of this.

What are alarm signs?

If a child displays behaviour that is dangerous to themselves or others, if they express suicidal intentions, develop eating disorders or fears that make their everyday life significantly more difficult. Parents know their child best. If they feel unsafe, they should contact a specialist centre. A phone call or an email exchange is often enough to put their worries into perspective. Parents don't have to do this alone. They should also recognise their own pain and not try to spare their children from it.

Why not?

If adults hide their pain and minimise it when they are asked about it, this can cause children to suppress their grief themselves. It makes them feel insecure. Some then display over-adapted behaviour in order not to burden their caregivers. Adolescents also have fine antennae in this respect - if they give the impression that they are not grieving, they may be doing so because they sense how vulnerable their environment is. However, we also know that for some young people the only coping strategy is often to play it cool and not respond to offers to talk.

What then?

I would look at the rest: Is the child well integrated socially, does he go to school and pursue his hobbies? If this is the case, many things are going well. There are ways of signalling to children that they are seen, even without words.

For example, you can take a cobblestone, sit down with the child and ask: What are things that would do you good in difficult moments? Be it being alone, a favourite meal or a movie night - draw the relevant symbol on each side of the cobblestone. If the child is in the mood, they can think about what they need from their carer and place the stone accordingly. Some children find it helpful to talk to their peers in a bereavement group; this is often easier for teenagers in particular. There are also good online programmes.

What can teachers do?

The first step is to get an overview: What is the child's level of information? How should the death be communicated at school? What is important to the family, what does the child want? Teachers should not be afraid to contact the family to discuss these things, as many children appreciate being able to decide for themselves how their loss is discussed in the classroom.

After a loss, children want a bit of normality at school, not a special status.

Most parents are open to it. Otherwise, I would still try to address the topic of death in class, because children are preoccupied by what has happened. This is also possible without going into the specific case. There are helpful books that provide teachers with practical help.

How can teachers support affected children in the long term?

I often hear from the children that they find it helpful when the teacher lets them know: If you need anything, I'm here for you, you can come at any time. The children all emphasise this: That they appreciate it when the teacher treats them normally when it comes to school matters. As a teacher, it is certainly important to take an interest and ask how the pupil is doing - but not all the time. After a loss, children don't want a special status at school, they want a bit of normality back.

Many people feel insecure when dealing with bereaved people and don't know what to say.

The worst thing would be to avoid the family because of this. Especially in the case of suicide, the family is afraid of doing something wrong. But: you don't have to say anything «intelligent» to the bereaved. Express your sincere condolences, refrain from giving advice and, if in doubt, keep it short: «I am incredibly sad about what has happened to you. I don't know what to say, I don't have the words.» What helps are offers of relief, although there are a few things to bear in mind.

Namely?

«Get in touch if you need anything» - the statement is well-intentioned, but bereaved people usually don't have the strength to ask for help. It is better for neighbours, friends and relatives to take the initiative themselves and make concrete suggestions for relief - taking on driving duties, doing something with the children, shopping, helping around the house. You can also simply leave a potato salad on the doorstep. The main thing is not to leave the family alone. The most important thing when dealing with mourners is the message: I am there for you.