When Students Encounter Death

This article begins with an overview of 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 they 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

Overview

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 children 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). Embedded 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 is initially 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 their 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 their mind and/or emotions that they are 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 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 have 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 in 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 skyscrapers, 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 other 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 their lives inductively, although they 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 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 their 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; from 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 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.

Further Insights

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 & Coping Model

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 well-being and behaviors and include positive and/or negative self-talk, expectations, assessment of circumstances, and confidence. As opposed to associating positive cognitions with those which are superior and negative cognitions with 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 terminal illness or the action-oriented responses that are elicited by cognitions. For example, parents who cognitively interpret that their child's terminal illness is unbearable may cope in several ways, including excessive drinking, working overtime at the office as a means to escape, or spending an inordinate amount of time with the child. Two types of coping are distinguished as those that are commonly utilized in terminally ill scenarios; palliative coping (Fortes-Ferreira, et al., 2006), which is emotionally based and embedded in fantastical illusions, and adaptive coping (Bailey & Smith, 2000), which proactively draws upon problem-solving and practicality.

Finally, the third component of the TSC model reviews the overall family functioning, which can vary from supportive, conflicted, or controlling; the latter of which is a common compensation to offset the unruly, disorganized feelings that oftentimes accompany terminal illnesses.

The Disability Stress Coping Model

The DSC Model helps ascertain how children adapt to their terminal illnesses by focusing on the interplay between both the risks and resistance factors that pertain to their state of affairs. There are three risk factors in the DSC Model that appraise the harmful aspects that may impede the child's coping strategies. The first includes the features of the actual illness, including the type of illness, expected length of the illness, how apparent the illness is to outsiders, and the level of incapacitation that the illness produces. The second risk factor focuses on the amount of autonomy the child is able to maintain (e.g., physical mobility), and the third risk factor highlights the psychological frustrations that correspond to living with the illness. There are three resistance factors covered in the DSC Model that underscore the ways in which children can resiliently combat their struggles. The first is the child's internal buoyancy, such as a strong sense of worth, a secure disposition, and the ability to assess situations rationally. The second focuses on the family's demographics, including economic standing, social class, and resourcefulness. The third assesses the child's command and management of the illness.

Death of a Family Member

Although people feel that burying one's parents is a sad yet natural part of the wheel of life, the expectation is usually that the parent is an aged individual who has led a quantitatively ample life. The reality is that a parent's untimely demise sometimes leaves young, vulnerable children who are unable to independently fend for themselves. In addition to emotions such as guilt, fear, anger, and depression or behaviors that include withdrawal, acting out, and poor academic performance (Scholzman, 2003), there are many issues that accompany the death of a parent, including shifting household dynamics (Cait, 2005). Both fathers and mothers may be ill-equipped to suddenly transition into single parenthood, and this difficulty is transcended onto the family as a whole. Not only are there practical details that affect family functioning during such a crisis, such as converting from a family of double-income earners to that of a single breadwinner, but the adjustment to new roles can be difficult.

For example, even in today's contemporary family, it remains common for the mother to tackle traditional household duties, including cooking, cleaning, and tending to the children's daily requirements and emotional needs (Johnson & Johnson, 2008). A father who undertakes the role of both mom and dad may feel disingenuous because he was not socialized to embrace these more feminine roles, and the kids might equally feel awkward approaching him with topics that had historically been reserved for the deceased mother. In the 2020s as gender roles become more fluid and households become more diverse, more research is needed on how one parent assumes the other’s role.

Another point of confusion following the death of a parent is if the surviving parent chooses to begin dating or eventually remarry ("Blended," 2003). Problems may be had by each member of the newly configured family dynamic, including the child who feels betrayed by the surviving parent for "cheating on" or "forgetting about" the deceased parent and resentment toward the new stepparent who has impossibly big shoes to fill as the surrogate parent. It is challenging for the stepparent to enter a setting in which the child is disgruntled, needs to be "won over," or refuses to obey disciplinary requests. Rituals that the deceased parent engaged in with the child are not readily accepted by a child in mourning, and he or she often rejects a stepparent's attempts to read bedtime stories, offer dating advice, or engage in festive ceremonies and mealtime routines.

The surviving parent is in an equally challenging position, in which he or she is emotionally invested in both child and newly acquired romantic partner/spouse and is therefore thrust into the role of the middleman during heated disputes. Finally, certain dates may be grueling for children to endure in the aftermath of a parent's death, particularly birthdays, holidays, Mother's/Father's Day, the anniversary of death, and special events.

When a sibling dies, the remaining brother or sister experiences a unique set of complexities (Paris, el al., 2009). In the instance of death from a terminal illness, in which parents have been occupied by the dying child's needs for quite some time, the healthy child commonly feels left out, jealous, and angry; emotions that are confounded upon a sibling's death when parents are busy with funeral arrangements and mourning their tragic loss. This convoluted mixture of emotions can either lead to guilt and/or behavior whereby the surviving child attempts to regain parental attention by acting with insubordination and rebelliousness. Such antics usually incite a cycle of interpersonal conflicts in which parents do not understand how their remaining child could demonstrate such insensitivity. This confusion is coupled with the fact that parents are in the throes of a raw state of bereavement that leaves little patience to deal with their remaining child's mischief, leaving them angry and even more inaccessible. Parents may add fuel to the fire of disengagement by placing more responsibilities on the remaining child to compensate for the fact that they are being pulled in so many directions. This parentification process requires that the healthy child step outside of his developmental age and carry himself in an adult-like manner by cooking meals, caring for younger siblings, and even making sure bills are paid (Stein, Rotheram-Borus, & Lester, 2007). Although it is normal for siblings to quarrel, the remaining child may also blame himself for such discord upon the death of a sibling, or he may fear that he is "next" in line. He may also fret over the gene pool he shared with his deceased sibling and worry about contracting the same terminal illness.

Discussion

Treatment Methods

There are a variety of techniques that schools can employ to help students who are terminally ill or those who are grieving the loss of a loved one. They include but are not limited to the following:

• Conducting parent-teacher trainings,
• Coordinating closure rituals, and
• Initiating group, individual, art/play, and family counseling.

Parent-teacher trainings are conducive to educating families and professionals on how to appropriately understand children who are ill or grieving and how to intervene accordingly. Most adults do not realize that the odd behavior their children and students are exhibiting may be standard expressions of grief, nor do they automatically have age-appropriate terminology at their fingertips that can soothe fears and help mend broken hearts. Psycho-educational trainings, workshops, and lecture series can help bridge the generational gap; parents and teachers can learn how to demonstrate genuine, heartfelt levels of encouragement. Closure rituals can allow students to say goodbye, which is especially meaningful if their loved one departed suddenly and accidentally. Children might write a letter to the departed (Lander & Graham-Pole, 2008/2009) and then bury it in a safe, remote location or tuck a note inside a balloon and watch it launch (Kandt, 1994). These procedures help resolve lingering clouds of guilt, sadness, and anger that loiter in many bereaved people's minds and prevent them from progressing on in their own lives.

Group, individual, art/play, and family counseling are techniques that school counselors can implement, however, if students require delving deeply into therapeutic terrain, they should be referred to appropriate mental health facilities. Group counseling is advantageous because it rallies together same-age peers who have undergone similar circumstances, which validates complicated emotions and experiences that the student would otherwise face alone. This helps remove the veil of stigma and shame (Quarmby, 1993). Individual counseling is ideal because it helps students advance beyond the private fears and barriers that obstruct their emotional growth at their own personalized pace. Art/play therapy can tap into the psyche unobtrusively and without using verbal articulation, which is useful for younger children and those who have been traumatized into suppression (Willemsen & Anscombe, 2001). Finally, family counseling provides the counselor with access to the family's overall dynamics and patterns of communication as opposed to treating each member in isolation from each other. This is attractive since the loss of a family member is a collective experience that the family as a unit endures (Rotter, 2000).

Conclusion

Western Society views death as an intimidating topic to broach, which manifests as a cultural obsession with youthfulness, since maturity and old age symbolize the last chapter of life that most people dread. Hence, people who approach a mid-life crisis should be viewed as expressing a fear of death that has been culturally closeted. When death's inevitability does pierce our realities, most people are grossly unprepared to deal with the harsh details that accompany this thorny and highly disregarded part of life. This trend is particularly true for children, whose inexperience often enables a cushion of naiveté that shelters their young lives until such an ominous circumstance invades. Early on, parents should expose their children to developmentally suitable discussions and field relevant questions that may arise, as well as introduce them to books and/or movies (e.g., The Lion King), which bestow knowledge about the delicacy of life. Ganga Stone, author of Start the Conversation: The Book about Death You Were Hoping to Find, advocates on behalf of acclimating people toward accepting their own mortality, and older teenagers and adults can engage in activities that offer such familiarization such as the following lease on life that is offered in her book:

Lease

Fine new body leased to Jane Jones for her temporary use.

Terms of lease: Expires at any time, at the manufacturer's discretion.

Obligations of lease: Body must be maintained by leaseholder at her own expense. Any improvements must be relinquished when the body is.

Termination of lease: Anytime, anyplace, no notice required, no appeals necessarily heard, leaseholder must vacate the premises on the spot, ready or not (Stone, 1997, p. 10).

Terms & Concepts

Concrete Operational Stage: According to Piaget, this cognitive stage of development occurs in children between the ages of six and 12 years. Children in this stage are able to understand mathematical skills such as adding, subtracting, multiplying, dividing, and group classifications more shrewdly. They are also able to contemplate the notion of reversibility, or the ability to overturn a person's deeds and thoughts, and, as it pertains to the concept of death and dying, the idea of irreversibility.

Disability Stress Coping Model (DSC): The Disability Stress Coping Model helps ascertain how children adapt to their terminal illnesses by focusing on the interplay between both the risks and resistance factors that pertain to their state of affairs.

Formal Operational Stage: The Formal Operational Stage begins once the child turns 12 years old and continues throughout the length of adolescence. Teenagers refine their ability for deductive reasoning. Children in this stage have refined their ability for systematic, methodical problem-solving, which can positively affect their family's grieving process.

Preoperational Stage: During the Preoperational Stage, children's utilization of symbols becomes both more advanced and more pervasive in other life arenas, including play. They have highly refined imaginations and are also egocentric in that they think everybody's experiences and perspectives match their own. In terms of their ability to reason, children at this stage engage in what Piaget called transductive reasoning.

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.

Transactional Stress and Coping Model (TSC): The Transactional Stress and Coping Model explains how terminally ill children manage their illnesses by focusing on the following concepts: Cognitions, coping strategies, and family functioning.

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Willemsen, H. & Anscombe, E. (2001). Art and play group therapy for pre-school children infected and affected by HIV/AIDS. Clinical Child Psychology & Psychiatry, 6, 339-350. Retrieved August 25, 2010 from EBSCO online database, Academic Search Complete, http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=5850269&site=ehost-live

Williams, K. C. (1996). Piagetian principles: Simple and effective application. Journal of Intellectual Disability Research, 40, 110-119. Retrieved August 25, 2010 from EBSCO online database, Education Research Complete, http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=17303493&site=ehost-live

Wiseman, A. (2013). Summer's end and sad goodbyes: Children's picturebooks about death and dying. Children's Literature in Education, 44, 1-14. Retrieved December 15, 2013, from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=85030282&site=ehost-live

Suggested Reading

DeVita-Raeburn, E. (2007). The empty room: Understanding sibling loss. New York: Scribner.

Singer, D. G. & Revenson, T. A. (1996). A Piaget primer: How a child thinks. USA: Plume.

Wright, H. N. (2004). Experiencing grief. USA: B&H Books.