When young lips have drunk deep of the bitter waters of Hate, Suspicion and Despair, all the Love in the world will not take away that knowledge.
RUDYARD KIPLING, Baa Baa Black Sheep
THE FOUR LONG accounts of children whose mourning failed, presented in Chapter 19, are intended to give an impression of some of the diverse patterns of pathological mourning seen in children and also of the ways that certain conditions can influence the form the responses take. The aim of this chapter is to examine these and other variants in more detail and the conditions that tend to promote each, and to give further illustrative examples. Once again the latter are drawn from the reports of clinicians working on both sides of the Atlantic: between them they represent almost every theoretical approach current within psychoanalysis. The fact that their empirical findings, when freed from divergent and often obscuring theory, are mutually compatible gives confidence in their validity.
It seems clear that some of the variants to be described, especially those in which self-reproach is prominent, are closely related to the chronic mourning of adults. Many others are characterized by a prolonged absence of conscious grieving. In some of the latter no psychiatric problem may be evident until many years later. In others problems of one kind or another appear fairly soon, during childhood or adolescence, and it is with these that this chapter is mainly concerned.
For purposes of exposition we consider the problems presented under a number of headings. They are chosen to reflect the great variety of symptoms and behavioural disorders that bereaved children show. The order in which they are discussed starts with those that are readily seen as responses to loss and moves on to those that, because combined with prolonged absence of mourning, may seem until examined to bear no relation whatever to loss.
What the incidence of each of these types of problem may be in a representative sample of bereaved children of different ages in a Western culture we have no means at present of knowing. Nor do we know the incidence of each relative to the others, since children with different symptoms and problems are likely to be referred to different types of agency, for example, somatic symptoms to a paediatric department, and behavioural problems to a probation service. All of what follows derives from studies concerned with small samples or with single cases.
Every student of childhood bereavement has noted how common it is for children who have lost one parent to be afraid lest they lose the other also—either by death or by desertion. Nor is it difficult to see how fear of such happenings, which is natural enough in the circumstances, can be increased, often very greatly.
Fear that the surviving parent will die is likely to be exacerbated by such unavoidable events as two or more deaths occurring in the family together, or the surviving parent in fact falling ill. Among conditions that are avoidable are leaving the cause of the parent’s death a mystery and discouraging a child’s questions about it, and also remarks which directly or indirectly lay responsibility on the child either for the death of the dead parent or for the state of health of the surviving one. Another circumstance that can easily be overlooked is the effect on a child of his hearing his surviving parent express the view that life is no longer worth living, that she wishes she were dead, or that suicide would be the best course.
Fear that the surviving parent will desert is clearly inevitable in a child who has either had such an experience, Visha for example, or in one who has been threatened with it. It will be aroused also should the surviving parent leave the children with relatives, or even strangers, and then go elsewhere for a time.
There is, of course, nothing inherently pathological about a child entertaining such fears, nor in his responding in accordance with them. What makes for pathology is when the fact that a child is afraid of such happenings goes unrecognized or, and more serious, when the circumstances that have exacerbated his fear are either suppressed or disclaimed by the surviving parent; for that is how an intelligible response becomes transformed into a mysterious symptom.
For a child to believe that, if his parent has died early, he will do so too is a natural enough type of reasoning, even if mistaken. Wendy provides an example (Chapter 16). Many others are given in the sources cited in Chapter 15. Since a child is likely to identify with the parent of the same sex, it seems likely that in boys fear of an early death is more likely to be aroused by death of father, and in girls by death of mother.
Furman (1974, p. 101) describes a little girl, Jenny, who was barely three years old when her mother died of an acute haemorrhage. Although her father did his best to inform Jenny about her mother’s death and what it meant, it transpired several months later that she remained worried lest her father, siblings and she herself might soon die. This became apparent when, after due preparation, she was taken to visit her mother’s grave.
Jenny’s visit to the grave with her father gave her an opportunity to voice her questions and her father an opportunity to answer them and so clarify the position. Too often, perhaps, such opportunities are not provided and a child’s very natural fear persists unnecessarily. The following account of a child of ten and a half whose mother had died five years earlier is taken from Kliman et al. (1973).
Norma was ten and a half when she came to psychiatric attention because of a variety of somatic complaints, including trembling and tingling sensations, anxiety about not being loved, and inhibited behaviour at school both in her work and in her social relationships. She did not want to marry and had thoughts of becoming a nun. At this time father was having many business worries.
Norma’s mother had died of cancer when Norma was five years old. At the time of her death mother had been in the first trimester of her fifth pregnancy. The illness had progressed fast and she had died only a month after cancer was first diagnosed. Father, shocked and grief-stricken, had withdrawn from the children and Norma had been placed in the care of an aunt and uncle who are described as having been harsh and inconsistent. (The account does not say how Norma’s three siblings were cared for.) Fourteen months later father married a widow with six children of her own and Norma returned to live with her father, her stepmother, her three siblings and the six stepsiblings—ten children in all. About a year after the family was reunited another tragedy befell Norma: a favourite uncle was killed in a car crash.
Following an introductory and supportive phase lasting three months, therapeutic work with Norma and her parents began to focus on the bereavement of five years earlier. Norma herself, who was seen weekly by a woman therapist, began asking questions about her mother and uncle and described how much she missed them. She seemed sad.
During the course of treatment Norma’s therapist took the opportunity to link Norma’s responses to interruptions caused by vacations, and also her responses to the anniversary of her mother’s death to how she may have felt soon after her mother had died.
The final sessions proved especially useful. Although Norma had been told seven months in advance that therapy was to end, she at first failed to remember it. Later she began to dread saying goodbye, a dread which her therapist linked to a previous painful goodbye when her mother had died. Norma also described a curious uneasiness about looking up at the building in which the therapist’s office was located; this proved to be related to waving goodbye to her dying mother who, when in hospital, had also been on one of the upper floors. Finally, in the very last session Norma voiced a question: ‘Did my mother die because she was having a baby?’ Only then did it become clear why Norma had decided not to have children and to become a nun instead.
Norma’s adverse experiences after her mother’s death were probably sufficient to have led to the problems from which she was suffering five years later. The account suggests she received little help from her father and that her experience during the fourteen months with her aunt and uncle was unhappy. On returning home, moreover, she was one of ten children and it is hardly likely that her stepmother was able to give her the affection and help of which she was in need. Other adverse events were an uncle’s sudden death and her father’s preoccupation with business worries.
During all these years, it is plain, Norma had been worrying about the cause of her mother’s death. The fact that she attributed it to mother having a baby is not unreasonable. Though we are not told the ages of Norma’s siblings, it seems fairly likely that one at least was younger than Norma and therefore that mother being in hospital was equated in Norma’s mind with the birth of a new baby. It is possible also that she had become aware of her mother’s current pregnancy. All this illustrates how necessary it is to give a bereaved child ample opportunity to ask questions about the causes of his parent’s death.
There is much missing from the published account, including any information about the relationship Norma had had with her mother. Nothing in the details given, however, suggests anything especially unfavourable.
Since children have greater difficulty even than adults in believing that death is irreversible, hopes of reunion with the dead parent are common. They take one of two forms: either the parent will return home in this world, or else the child wishes to die in order to join the dead parent in the next. No doubt these hopes and wishes are greatly strengthened by certain circumstances. Promises made to a child shortly before a parent’s sudden death that go unfulfilled may be the source of raised and poignant hopes. Kathy’s father, it will be remembered (Chapter 16), had promised to take her to the candy store but had entered hospital and never did so. Many a parent on entering hospital as an emergency, never to return, must have promised the children to be well again and back soon.
Other circumstances which strengthen these hopes and wishes are when the child’s relations with the dead parent have been good and the conditions in which he is being cared for afterwards are especially unhappy.
The following account of a boy who lost his mother when he was four years old, by Marilyn R. Machlup, is taken from Furman (1974, pp. 149–53).
Throughout Seth’s babyhood his mother had suffered from lassitude and her condition became worse after the birth of a younger sister, Sally, when Seth was three and a half. A few months later mother fell out of bed and could not get up. Only then was the illness taken seriously; and it was arranged for her to be admitted to hospital for investigation. A fortnight later mother packed her bag, said goodbye to the children and was taken by car to the hospital. The next day she died. The last Seth had seen of her was when she got into the car.
Mother’s death came as a great shock to father. Nevertheless he did all he could to inform Seth what had happened. His mother, he told him, had died: ‘She had stopped eating, breathing, moving and feeling, and her body would be buried in the ground.’ Seth was sad and cried briefly. But he made no comments and asked no questions. He did not go to the funeral nor did he see his mother’s grave until a year later. When eventually father heard what the illness had been (leucaemia) an opportunity to tell Seth about it seemed never to come and there was no further discussion between them.
After mother’s death father and the two children moved into his parents’ home. The grandparents were warm loving people who did all they could for the children. They even sought professional help for Seth to help him talk about his feelings and memories of his mother, but this was unsuccessful. Father was of no assistance since whenever reminded of his wife he became despondent and could not bear to talk about her or about the past.
At nursery school Seth was described as a good and nice boy but lacking in spontaneity. Sometimes he asked where his mother was; but he made no other mention of her.
When Seth was six, two years after mother’s death, father remarried, and the family moved into their own apartment. Contact with the grandparents ceased partly with the aim of strengthening Seth’s tie to his stepmother. This relationship proved most unhappy, however, in large part due to stepmother’s own emotional problems. She was extremely aggressive towards Seth; and a few months after marriage she developed an acute neurotic depression, for which she was in hospital for a month.
After the change of living arrangements Seth became disturbed and difficult. In particular he was hyperactive, ran out into the street and jumped from high places, all without any regard for safety. In addition, he threw temper tantrums, was destructive of his clothes, and both wet and soiled himself. Because of these troubles he was accepted for psychotherapy.
It was soon evident that Seth was much preoccupied with his mother and why she had died. He was also afraid he might have caused it. Amongst much else he recalled the occasion when his mother had fallen out of bed and how powerless he had been to help her. Seth’s father on learning of these worries found an opportunity to explain to him about mother’s illness in some detail; and later they visited the grave together.
Seth’s stepmother resented his relationship with the therapist and, because of this, it was decided to end therapy prematurely. This upset Seth and he resumed behaving in a hyperactive and dangerous way . . . He wanted to get hurt, he said, then he would be taken to hospital and die. He also expressed an earnest wish to get in touch with his dead mother. He held long ‘conversations’ with her and strung tape ‘wires’ across the therapy room in order to telephone her. Often the therapist had to restrict his climbing; but one day he climbed on to a windowsill, fell and broke his elbow.
Looked at from Seth’s point of view mother’s increasing lassitude, alarming fall and sudden disappearance into hospital must have been a complete mystery. Although father had evidently done his best to tell him about his mother having died, it is plain that the four-year-old Seth had entirely failed to grasp the situation, either in regard to what had happened or why it had happened. It seems likely that father implicitly discouraged questions at the time; and we know that subsequently he could not bear to talk about his wife or the circumstances of her death. Inevitably Seth was left in a sea of uncertainty.
It should be noted that when Seth’s mother went to hospital it was for an investigation: no one had expected her to die. Before her departure, we are told, she had said goodbye to the children. In such circumstances, it is not unlikely that she would have indicated to them that she would soon be back. Had this been so, it would greatly have encouraged Seth’s continuing hope of her return. Nor is it surprising that after his father’s remarriage and the loss of his grandparents, and again before the impending loss of his therapist, Seth’s desire to find his mother became increasingly urgent.
More is said in the last section of this chapter about the accident he sustained shortly before ending therapy.
There are no doubt many other motives for a child wishing to be in touch with his dead parent, even to the point of dying in order to be with him or her. One such might be the desire to mend a relationship that had been damaged, perhaps by a quarrel, shortly before the parent died. The following account of a therapeutic session with a six-year-old boy who had lost his father three months earlier illustrates the point. The account is taken from a report by Martha Harris (1973), a child analyst on the staff of the Tavistock Clinic.
James’s father had died in hospital after a short illness. At the time James had been staying with friends and it was some weeks before he was told what had happened. He had not attended the funeral nor had he visited the grave.
James had an elder brother, Julian aged eight. Of the two, Julian had always been the easier and had enjoyed ‘a more peacefully loving relationship with his father’. James, by contrast, is described as having a more difficult temperament, and as forceful, aggressive, intelligent and passionate, and as closely attached to his mother. With his father he had not always got on well; mother thought they were too much alike. When his father had shouted at him James had shouted back.
After being told of their father’s death the two boys had responded very differently. Whereas Julian had wept a good deal and had become very close to his mother, James had become angry and ‘a torment’. In particular, he could not tolerate seeing his mother and brother looking sad. To his mother he would say accusingly, ‘You’re no good! You can’t keep people alive!’ Julian had asked her in bewilderment, ‘What’s the matter with James? Why does he always try to make me cry?’ At school, which James had formerly enjoyed, he had become grumpy and inattentive and was always picking quarrels with other children. After a tantrum one day with his mother he had broken down and exclaimed, ‘I’m horrible, but I don’t know why.’ This had led her to seek advice. In coming to see a therapist, he was told, he would be seeing a lady who would try to help him understand why he felt so horrible after his father’s death.
James came readily to the therapist’s room and dived immediately into an open drawer of toys made ready for him. He rummaged through it as though looking for something in particular. His therapist remarked on this and asked him whether he knew what it might be. ‘Yes,’ he replied, but said no more and continued rummaging. Then he stopped and looked puzzled, which led the therapist to enquire whether perhaps he was looking for Daddy. ‘Yes,’ he replied immediately. Thenceforward he poured out his thoughts and feelings in a way that was not always easy to follow.
He started: ‘Yes, my father’s dead and I’d like to see him. I don’t know where he’s gone. Yes. I know where he is, he’s in heaven . . . I know he’s in heaven and not in hell.’ He wondered what heaven was like. His therapist remarked that he wanted to believe that his father was in a good place and was happy. With this he agreed intensely. When after further talk the therapist referred to his being uncertain where his father was, he retorted: ‘But I know where he is . . . but I would like to see him again . . . sometimes I think I must commit suicide and go to see my father.’ Asked how he thought of doing it, he replied, ‘With a sharp knife, or get very ill and then die . . .’
His therapist said she thought that he was uncertain how he felt about his daddy, that he didn’t want to think of his daddy being cross or of his daddy being in a bad place . . . At length James looked up and said emphatically, ‘One thing I know . . . just three words, I would like to say . . . I—loved—him.’ His therapist concurred but added that maybe there were times also when he did not love daddy. To this he replied, ‘I wish he hadn’t shouted at me . . . I shouted back at him.’ When asked if he thought his shouting could have made daddy ill, he looked at his therapist intensely and asserted: ‘When you’re little you’re very very strong and when you’re old, even if you can shout loud, you get weaker and weaker and then you die.’
Later he added sadly, ‘Sometimes I forget what he looks like . . . I try to think of him and he’s not there.’ His therapist referred to his being worried at being unable to keep a true picture in his mind of a daddy he loved. ‘I’ve got two pictures of him in my room . . . in one of them he’s not smiling . . . I don’t like that . . . I like the one when he’s smiling.’ At the end of a long session, during which his therapist had made a number of interpretations (mainly of Kleinian origin), James reverted to the theme of suicide: ‘I don’t want to commit suicide . . . no, I’ll commit suicide with all my family and then we can all be with daddy.’
One further theme arose just as the session was ending and the question of another one was being discussed. James got up from the floor and sat in the armchair. This led his therapist to remark that maybe he was wanting to be the daddy who made the arrangements; perhaps it was that that had led to the trouble between himself and his father which had ended in their shouting at one another. ‘Yes,’ said James, ‘and that’s the trouble with Julian now because he wants to be daddy too.’
After this first session James began to talk to his mother about his father. He asked for details of his illness and expressed the wish to visit the grave. Relationships at home became easier. ‘Though initially he had no wish to come to the clinic again, later on he came for a further six sessions at weekly intervals.
There can be no doubting James’s urgent desire to see his father again, even if it meant his dying too; nor that his main concern was to assure his father that he loved him. This suggests rather strongly that shortly before his father left for hospital the pair had quarrelled, that father, perhaps, had shouted at James and that no opportunity had subsequently arisen for James to make his peace with father. Certainly a reading of the account gives the impression that, whatever occasions of friction there had been in the past, the pair had been on reasonably good terms and that in ordinary circumstances quarrels would have been made good fairly quickly.
How and why these strained relationships should have developed between them is not clear. Obvious possibilities are that father had tended to favour his elder son at the expense of the younger and/or that he resented James’s close relationship with mother.
Since it is hardly to be expected that a six-year-old would talk about committing suicide in order to see his dead father unless he had overheard someone else talking in this vein, we are left to speculate who it might have been. On the information given, the most likely person would appear to have been his mother.
Nothing is easier for a child than mistakenly to blame someone, including himself, for having caused or contributed to a parent’s death. There are two reasons for this: first, a child is unclear in general about how deaths are caused; and secondly, children not unnaturally put much weight on what they see, what they hear and what they are told.
In the study by Arthur and Kemme (1964) no less than 40 per cent of the children and adolescents were attributing the cause of the parent’s death either to themselves or to the surviving parent and, as we have already seen, why they were doing so was often quite explicit. A child will blame himself whenever the parent who later dies, or the surviving parent, has sought to control him by reiterating that his behaviour—noisy, dirty, troublesome, naughty or however else designated—is making his parent ill, or ‘will be the death’ of him or her. A child will blame the surviving parent when he has seen one of them attack the other or has heard threats to do so.
The following account of a child of six whose mother had died two years earlier, by Myron W. Goldman and taken from Furman (1974, pp. 140–8), illustrates this point and several others also.
Addie was five years old when she came to psychiatric attention because of a rigidly stiff neck for which no organic cause was found. In addition, maternal grandmother was complaining that Addie was wilful and disobedient, and had difficulty in falling asleep. Although the stiff neck had subsided after the psychiatrist had talked with her about her mother’s death and the anger she must feel at her father for having gone away, it was evident that Addie still had many difficulties. She was therefore admitted to the therapeutic nursery school and, when she was almost six years old, began seeing a male child-therapist five times a week.
Addie’s mother had died from leucaemia two years earlier, having previously been in hospital several times. On these occasions Addie and her sisters, one year and two-and-a-half years younger, had stayed with their maternal grandparents; and since mother’s death they were doing so again. These grandparents, who also had two teenaged sons of their own (Addie’s uncles), are described as maintaining ‘a solid decent family life, with close-knit warm relationships’. They lived in a black area of the city.
Mother had been in her mid-twenties when she died, having married young. Her husband was a handsome and charming man, two years her senior, who had turned out to drink heavily and to be abusive and delinquent. He never supported his family and had spent a year in a reformatory when Addie was a toddler. During Addie’s fourth year father often was not at home but would force his way into the house and then leave again, unpredictably. After mother had died he left the city, having told grandmother that it was up to her to take care of the children.
Addie and her sisters had been told next to nothing about their mother’s illness and death, nor about their father’s desertion. The first Addie had heard of her mother’s death was when, two weeks later, a neighbour’s child had told her she had been at the funeral; and only then had the grandmother admitted it to the children. Throughout, in fact, grandmother was extremely averse to talking about her daughter’s death or mourning her. One reason for this, it appeared later, was her persistent feelings of guilt for not having taken action about her daughter’s illness earlier.
In view of grandmother’s silence it is hardly surprising that Addie was extremely confused about her mother’s illness and death. One of the ideas she expressed to her therapist was that her mother was still alive and would return. Another was that her father had killed her mother; though this she quickly corrected to saying that her mother had been sick and had died. Nevertheless, when she was anticipating her therapist’s summer vacation Addie was afraid lest he be killed by her father. Subsequently during therapy Addie began to recall how her father used to hit her mother, and many other frightening details of her family life—how her father got drunk, how he ate the food leaving none for the rest of the family, how her mother had to call in the police. Later still she described how the mother of a friend had died in a fire and how the friend had failed to rescue her. This led on to Addie recalling with remorse how on one occasion she had persuaded her mother to let her father back into the house and how he had then proceeded to beat mother.
About two years after the start of therapy Addie suffered a recurrence of her stiff neck. An aunt who closely resembled Addle’s mother had suddenly appeared at the house, which led Addie at first to believe that her mother had returned; and during the aunt’s two months’ stay Addie had become extremely attached to her. Nevertheless, when the aunt left and everyone else in the family missed her, Addie was an exception. It was then that she developed the stiff neck. Discussion of this sequence led to Addie recalling her mother’s many visits to the doctor and how perplexed this had made her. Among other interpretations the therapist made about Addie’s stiff neck was its resemblance to her mother’s stiff body which the neighbour’s child had described seeing in the funeral home.
This led on to Addie visiting her mother’s grave for the first time. By enabling Addie thereafter to grapple with the concept of death, this visit proved a turning-point in the therapy.1 Attempts to help Addie experience her sadness and longing for her mother proved difficult, however. One cause for this was that grandmother was unable to mourn her daughter’s death and, whenever reminded of sad feelings, burst out in anger. Another cause lay in the family relationships that had existed before mother died. Addie’s mother had been chronically depressed, whilst Addie’s father had repeatedly rejected her. As a result Addie had concluded that ‘if you show warmth you expose yourself to being hurt’ and had therefore developed what the therapist describes as ‘a hard, brittle attitude’.
When the circumstances of Addie’s family life are borne in mind, it is easy to see why she had the idea that perhaps father had killed mother, and might also, possibly, kill her therapist. It is also easy to see why she felt guilty about having played some part herself. When parents quarrel a child will often seek to protect the one attacked and will feel guilty if, unintentionally, he does anything that endangers one of his parents.
Moreover it is not difficult to see why Addie had developed compulsive self-reliance. Her mother had not only been ill and depressed but had also had two other children to care for, one of them only a year younger than Addie; whilst father’s erratic and brief returns to the family only provided further occasions for Addie to feel rejected by him. In these regards the overall clinical picture of Addie resembles closely that of Geraldine (Chapters 19 and 20).
Comments about Addie’s stiff neck are deferred to the section dealing with somatic symptoms.
When a child is sad a surviving parent has no difficulty in recognizing it as a response to loss. When, by contrast, a child is distractible and overactive, or perhaps engages in aggressive or destructive outbursts, to recognize it as being also a response to loss is much more difficult.
There is, moreover, a vicious circle here. Children who respond in the ways described, the evidence shows, are commonly the children of parents who themselves have little understanding or sympathy for a person’s desire for love and care, either their own or their children’s. After a loss, therefore, these parents are extremely likely to stifle their own grief and to be especially insensitive to how their children are feeling. This interactional process is well illustrated in the case of Arnold, a boy of five, described by Furman (1974, p. 58).
Arnold’s father died suddenly when Arnold was five and a half. Soon afterwards he became overactive and would not tolerate any mention of the death; nor would he stay in the house when a family member cried. This led him to absent himself from home for long periods and at unexpected times. His explanations were lengthy and involved but never to the point.
Both Arnold’s parents, but especially his mother, had apparently always been blind to how their children might be feeling; and mother herself tended to avoid expressing feeling; instead she gave explanations and rationalizations. After her husband died she, like Arnold, failed to mourn him. Inevitably, therefore, she failed to understand why he behaved as he did.
In many cases, it is apparent, the angry outburst and/or withdrawal from the situation are the ways that a child who is unable to mourn responds whenever the death is mentioned. Henry, it will be remembered from Chapter 19, responded to his father’s death much as Arnold did. Not only did he fail to mourn and instead became restless and distractible, but he responded angrily whenever his therapist broached the subject; and on at least one occasion he ran from the room. Adults who fail to mourn are apt to respond in much the same way. Not only do they avoid all mention of the loss themselves but they are apt to respond testily should others do so see (Chapter 9).
An example of a boy whose response to his father’s death was not unlike Arnold’s and whose family experiences had evidently been of the same kind, though probably even more adverse, is reported by William Halton (1973), a child psychotherapist working at the Tavistock Clinic.
Howard was aged eleven when his father died suddenly of a heart attack. He decided he did not wish to go to the funeral and, after crying briefly, announced that he would not cry again: ‘You only cry once.’ His mother was worried at his lack of grief.
At the time of his father’s death Howard had already been in treatment for two years because of behaviour that his parents found ‘wild and unmanageable’. After the loss, which happened to occur a mere two weeks before his therapist’s vacation, he became particularly hostile and threatening towards his therapist.
On the first occasion that Howard came for therapy after his father’s death he looked very white and seemed unnaturally cheerful. Nevertheless, he was in an irritable mood and soon picked a quarrel. In subsequent sessions among the many other hostile remarks he addressed to his therapist were the threats: ‘I’ll do some permanent damage to the room. Smashing you would be really worthwhile, because then no one would want to know you.’ Despite these emphatically expressed sentiments, however, the therapist was able to recognize what seemed to be signs that Howard was also desiring comfort from him but was despairing of ever receiving it.
In this case, as in so many others recounted in this and the previous chapter, failure to mourn his loss and angry avoidance of the subject reflected the very impaired relationships Howard had had with both his parents over many years. In briefest outline, it appears that he had been adopted at the age of four weeks but had not been told of it until he was nine years old. Both parents had had high hopes of him but these had later turned to ‘resentful disillusion’. Mother (who seems to have had major emotional difficulties of her own) ‘found any physical demonstration of affection embarrassing’ and was accordingly much relieved when at some point in his development Howard had no longer demanded it. When she was depressed and he was troublesome there were occasions when ‘they just screamed at each other’. Howard’s relationship with his father was thought to have been better during the first few years of the boy’s life but father had been ill and away in hospital for several months during Howard’s fourth and fifth years and, after that, father felt he had never been able to make contact with him again.
In many, perhaps all, of those who respond to a loss with overactivity and/or anger, whether they are children or adults, a feeling of guilt for having been in some degree responsible is playing a part. Although this is not commented upon by Halton, I suspect it was playing a part in Howard’s case also. In the first place, father had had serious heart trouble since Howard’s earliest years; in the second Howard’s behaviour is described as having been wild and unmanageable. Implicitly or explicitly, it seems likely, Howard was given to understand that his behaviour was responsible for making his father worse. If that was so and he was blaming himself for his father’s death, it is hardly surprising that he was unwilling to express it to an adult who, judged in terms of his past experience, he would expect to be unsympathetic or indeed hostile. Many difficult and aggressive children operate on the principle that attack is the best means of defence.
The importance of a hidden sense of guilt in accounting for a person’s difficult behaviour is well illustrated by the case of a boy of ten, Walter, described by Wolfenstein (1966). Unlike Arnold and Howard described above, Walter was not seriously disturbed.
Walter was eight when his mother developed breast cancer and had an operation. Thereafter he was cared for increasingly by his maternal grandmother, whom he already knew well; and this arrangement continued after mother died two years later. Despite grandmother’s devoted care, however, Walter became chronically irritable with her and on one occasion after she had rebuked him for something he retorted angrily that he was leaving home; he then stormed out of the house. Fortunately his grandmother realized that he was still upset by the loss of his mother and, after he had returned, began to talk to him about it, remarking how sad both of them were. After she had told him about all the efforts that had been made to save his mother’s life, Walter confided to her how he might be partly to blame. After his mother had returned home following her operation she had been very weak. Despite that, however, she had got up every morning to give him his breakfast before school. Had she not done so, he thought, she might not have died. The discussion, which went on late into the night, cleared the air.
Walter was fortunate to have a sympathetic and insightful grandmother, who provided him also with the substitute parenting that is so necessary for a bereaved child. Within this relationship of trust, and given an opening, he was able to confess his misgivings.
In advancing the view that a burdensome sense of guilt lies frequently behind hostile and aggressive behaviour I am conforming to views expressed over the years by a large number of psycho-analysts. Where my view tends to differ from theirs is in how the development of an oppressive sense of guilt is to be accounted for. Whereas traditional theory lays heavy emphasis, to the exclusion of almost all else, on the role of hostile wishes harboured by the guilty survivor against the dead person, in my judgement the evidence points more clearly to the influential part that is played by the way a child is treated within his family. Consider, for example, the effects on the way he construes events of a child’s ignorance of the true causes of family misfortunes, including illness and death; especially when, in addition, he is being influenced by what his parents and others are saying to him. Thus, censorious remarks, made in unguarded moments, can readily lead a child to believe that every misfortune stems from his own ‘selfish demands’ or his own ‘aggravating ways’. Moreover, when calamity strikes, a distraught parent can all too easily lash out in unthinking reproach against whoever may be nearest—and not infrequently this is a young child. When we add to the guilt arising from these episodes the guilt systematically induced in their children by some parents in order to control them, we find no lack of external pressures to account for the development of a child’s morbid sense of guilt after a parent has died.
Analysis of the problem along these lines, moreover, shows that anyone treated by a parent in these kinds of way is not only likely to feel guilty but likely also to feel resentful, perhaps bitterly resentful, against that parent. Thus the festering presence of hostile wishes against the dead person is accounted for also. This means that the theory advanced here not only respects the data on which traditional theory is built but gives them a significant place within a more comprehensive framework.
The account of Visha given in Chapter 19 illustrates how a child of ten came to feel constrained to look after her mother instead of expecting to be cared for herself. Even before her father’s death Visha had had to act as the go-between in her parents’ marriage and had come to feel responsible for their happiness. After his sudden death she had feared lest her mother break down and had felt therefore it was necessary for her to ‘hold together’ and take responsibility for her mother’s state of mind. The background to this, of course, was her mother’s unhappy childhood: mother’s father had died when she was four and her mother had been too busy to give her time or affection. Although it is recognized that Visha resented finding herself in the caregiving role, it seems likely that, had there been no therapeutic intervention, she would nevertheless have found herself trapped irretrievably in it.
Earlier, in Chapter 12, it was remarked that in the histories of persons given to compulsive caregiving two rather different types of childhood experience are found. In the one a child is made to feel responsible for the care of a parent: this was clearly so in the case of Visha, as it was also in the case of Julia see (Chapter 12). In the other the disposition follows intermittent and inadequate mothering culminating in total loss. The persons towards whom the caregiving is directed are usually different in the two types of case. After the former type of experience, the caregiving is likely to be directed towards a parent or, in later life, a spouse. After the experience of intermittent and inadequate mothering it may be directed in a less specific way, for example towards other children, including strangers. It is in those cases especially that a child, after having lost all effective parenting, develops a pattern in which, instead of his being sad and longing for love and support for himself, becomes intensely concerned about the sadness of others and feels impelled to do all in his power to help and support them. In this way the cared-for person comes to stand vicariously for the one giving the care see (Chapter 9). This seems to have occurred briefly with the four-year-old Kathy who, soon after her father’s death, became much concerned about the welfare of another child who had also lost his father (Chapter 16).
Another example of this is the case of Patricia,2 a nineteen-year-old girl, described by Root (1957), who had come into therapy because of recurring attacks of sickness and nausea, with general anxiety and depression. The symptoms had developed soon after she had got married, two years previously.
One evening when Patricia was ten and a half her mother had been killed instantaneously in a road accident. Her father had been driving. At first, Patricia and her brother, two years older, had been told that mother was in hospital. Next day they learned she was dead.
Patricia, we are told, had already had ‘much experience of missing her mother who had all along continued her work as a teacher and had done much home tutoring’. Patricia had been mostly in the care of a maid. Mother, who was the mainstay of the family financially, is described as having been ambitious, conscientious and constantly worried about the children’s behaviour and health. Emetics and enemas were in frequent use; and only when Patricia was ill did her mother show her much concern. Like mother, father demanded high standards and even when Patricia did well he criticized any deficiency there was. Both parents seem to have favoured the elder brother.
After her mother’s death Patricia took over responsibility for running the home. Since her father and brother gave her no help, this became a drudgery which she keenly resented whilst continuing conscientiously to do it. Later she recalled times when she had missed her mother, for example when she started her periods and also after occasions when her father had been especially thoughtless and critical.
In these circumstances it is not surprising that during her teens Patricia was eager to get away from home. Having done well scholastically therefore, she went off to college when only sixteen. She was impatient to be grown up and to have a family of her own; and within nine months she had got married to a fellow student.
Her husband’s childhood had been no happier than her own. His mother had suffered from a chronic illness and had died when he was ten, the same age that Patricia had been when she lost her mother. He had the reputation of being a bitter person and Patricia had taken it upon herself to help him over it. As a result she shouldered all the responsibilities, and soon came to feel burdened by his dependence on her. Sexual relations were not happy. Soon after the marriage she became depressed, felt unable to concentrate, quit college, and spent much of her time in bed.
During treatment the first statement that Patricia made about her mother was that she was ‘a wonderful woman’. Since this remark was made with emphasis but without emotion her analyst suspected that Patricia’s feelings for her mother were not unmixed, which later became evident. He noted also that Patricia ‘could not at first comprehend, even intellectually, that she missed her mother’. Nevertheless, she was deeply concerned about the misfortunes of others and, in Root’s words, ‘often displaced her sadness onto something else or felt sad for someone else’. For example, she could shed tears for an orphaned beggar girl. Later in the analysis it transpired that she had not believed that her mother had died and had never expressed grief either at the time or later. Yet it was evident that she was much preoccupied with thoughts of her mother. For example, in her dreams and fantasies her mother constantly appeared. In some of them there was a happy reunion. In others she had a picture of her mother in a sanatorium or witnessed a frightening scene of her mother with head and face injuries. As time went on she became more able to mourn her mother and described how this seemed like ‘letting her mother go’. She also remembered how she had felt when, at the age of seven, a maid to whom she had been attached had left. There had been a tearful parting which in the analysis had been recalled with much emotion and weeping.
There are so many features in this case that we have met before that not much comment is called for. Patricia’s childhood seems to have been rather like that of Visha’s mother; each had a capable mother who was so occupied in a teaching career that neither daughter saw much of her and, instead, each was left to the care of maids. To at least one of these maids Patricia had developed a strong attachment and she had suffered commensurately when the maid had left. Thus it seems clear that already before her mother’s death Patricia had suffered from her mother’s frequent absences and from the loss of at least one substitute to whom she had been attached.
After her mother’s death she had failed to mourn and had suppressed, so far as she was able, her sadness and yearning to be cared for. Instead, she had tried hard to be the well-behaved and helpful child her mother had expected. Thus she strove to be grown up and independent, with an element of compulsive self-reliance. Yet she was drawn to those who, like herself, had been bereaved, and found herself both grieving for them and caring for them. The man she chose to marry was, she believed, in need of her care and seems hardly to have been likely to care for her.
It is uncertain why exactly Patricia broke down after her marriage, though it is clear that she had burdened herself with responsibilities which were far too great for her previous mental condition. As regards her somatic symptoms, it is not unlikely that, as Root suggests, they were related to the fact that it was only when she was unwell as a child that her mother had given her much time or care. Her sexual difficulties are likely, I believe, to have been secondary to her interpersonal ones.
Two of the cases described in Chapter 19, those of Henry and Geraldine, well illustrate how a bereavement greatly intensifies any tendency a child may already have towards abjuring his desire for love and proclaiming instead his total self-sufficiency. In both the history of unhappy relations with mother give clear indications of why each child had developed in this way. The same type of background is present in the case of Patricia, though her subsequent self-sufficiency is less in evidence than her compulsive caregiving.
In his description of the treatment of a married woman of twenty-seven with severe emotional difficulties, Mintz (1976) quotes some remarks of the patient that reveal in a dramatic and tragic way the predicament in which a child of four found herself when bereft of any attachment figure.
Mrs G came for analysis because she felt irritable, depressed and filled with hate and ‘evil’. In addition she was frigid with her husband, felt emotionally detached and wondered whether she was capable of love.
When Mrs G was three her parents were divorced. Her father left home and her mother, who began working long hours, had little time for her. A year later when Mrs G was four she was placed in an orphanage and remained there for eighteen months. Thereafter, although back with her mother, family relationships continued disturbed and unhappy. Mrs G left home early; before she was twenty-one she had already been married and divorced twice. Her present husband was her third.
In the early phases of the analysis Mrs G was extremely reluctant to recall the painful events of her childhood; and when she did so she broke down into tears and sobbing. Nevertheless, her analyst encouraged her to go over them and to do so in minute detail since he believed this would help her. At the same time he paid at least equal attention to her relationship with himself in which, as would be expected, all the interpersonal difficulties that she had had in other close relationships recurred.
Amongst much else in her childhood that was painful, Mrs G recalled how sad she had felt when she parted with her pets when she was sent to the orphanage. Sometimes she dreamed about her time there with feelings of being overwhelmed. She recalled feeling very small among the many children, how there were no toys, the harsh treatment, and how she had sometimes misbehaved deliberately in order to get smacked.
Inevitably the emotional conflicts in Mrs G’s relationship with her analyst became more acute when, after four years, it was decided to end the treatment after a further six months for financial reasons. Mrs G now dreamed and daydreamed more openly of her analyst. She had realized from the first that parting would be painful. Separations had always made her angry and, as she put it, ‘anger makes me sad because it means the end . . . I’m afraid you’ll leave me or kick me out or put me away.’ The analyst reminded her of her feeling when sent to the orphanage. Struggling to think of herself as self-sufficient, Mrs G exclaimed: ‘I’m clinging on to me . . . I’m taking care of me all by myself.’
A few months later as termination approached, she linked how she felt about her analyst with how she had felt earlier about her mother: ‘I don’t want to release my mother—I don’t want to let her go—she’s not going to get rid of me.’ Active yearning for love and care, and anger at those who had denied it her, had returned.
Other episodes showed how, within the supportive analytic relationship, she had become able to bear the pain of longing and grieving. For example, during the early days of the analysis Mrs G’s cat had died but she had felt indifferent about it. This she had explained: ‘If I let it hurt me, I’d be saddened by everything. One will trigger off the rest.’ Towards the end of the analysis, however, when another cat died, she wept.
Although therapy had restored this patient’s feeling life and had resulted in her becoming able to make improved relationships, including that with her mother, a follow-up five years later showed that, as would be expected, she remained vulnerable to situations that arouse anxiety and sadness, such as separation and loss.
There are, of course, many similar cases on record of compulsive self-reliance having developed after a childhood bereavement, for example in the papers by Deutsch (1937) and by Fleming and Altschul (1963). In few, if any of them, however, is adequate information given about personality development and family relationships prior to the loss, about the circumstances of the loss, or about what happened after it, including what and when the child was told. The reason for these omissions is partly that most of these patients came into treatment many years after the loss had occurred, and partly that at the time they were treated the clinicians concerned were unaware how relevant these matters are.
Nevertheless some of these cases have an interest far beyond the historical. In particular some of them document with great clarity how, beneath the hard shell of an adult’s proclaimed self-sufficiency, there lies dormant a strong yearning to be loved and cared for. The following is taken from the seminal paper on absence of grief published by Helene Deutsch in 1937.
The patient was in his early thirties when, without apparent neurotic difficulties, he came into analysis for non-therapeutic reasons. The clinical picture was one of a wooden and affectionless character. Deutsch describes how ‘he showed complete blocking of affect without the slightest insight. In his limitless narcissism he viewed his lack of emotion as “extraordinary control”. He had no love-relationships, no friendships, no real interests of any sort. To all kinds of experience he showed the same dull and apathetic reaction. There was no endeavor and no disappointment . . . There were no reactions of grief at the loss of individuals near to him, no unfriendly feelings, and no aggressive impulses.’
As regards history, we learn that his mother had died when he was five years old and that he had reacted to her death without feeling. Later he had repressed not only the memory of his mother but also everything else preceding her death.
‘From the meager childhood material brought out in the slow, difficult analytic work,’ Helene Deutsch continues, ‘one could discover only negative and aggressive attitudes towards his mother, especially during the forgotten period, which were obviously related to the birth of a younger brother. The only reaction of longing for his dead mother betrayed itself in a fantasy, which persisted through several years of his childhood. In the fantasy he left his bedroom door open in the hope that a large dog would come to him, be very kind to him, and fulfil all his wishes. Associated with this fantasy was a vivid childhood memory of a bitch which had left her puppies alone and helpless, because she had died shortly after their birth.’
Some measure of euphoria is a not uncommon feature of children and adolescents who fail to mourn. Kathy (Chapter 16), Henry (Chapter 19), and Howard (this chapter) are all examples. An explanation of this response is not easy. Several motives appear to be playing a part.
In some cases, it seems likely, euphoria is an expression of relief that irksome restrictions imposed by the dead parent will now be lifted. This motive may have been playing a part in Henry who had been up against his disciplinarian mother, and perhaps also in Howard. It was this motive that seems to have been playing a part also in the case of the woman in her early forties who had separated from her husband after nearly twenty years of marriage whose account of her experience (reported by Weiss 1975) is quoted in Chapter 9.
In seeking other motives for a euphoric response we can take a lead from the four-year-old Kathy whose healthily progressing mourning for her father is described in Chapter 16. During the early weeks, when Kathy alternated between being sad and a little euphoric, she asserted candidly ‘I don’t want to be sad’. Some months later, moreover, when she was trying to understand why her father should have died, she made it plain that she had connected his looking sad with his having died: ‘I always felt if you’re very happy you won’t die.’ To be very happy, therefore, or rather to convince yourself and others that you are happy, is a safeguard against dying yourself.
It seems likely that some cases of overactivity can be explained, at least in part, in the same way. Mitchell (1966) points out, discerningly, that the most typical and also the most frightening characteristic of a dead animal or a dead person is their immobility. What more natural, therefore, for a child who is afraid he may die than for him to keep moving. Notions of preserving others of the family from dying, or even of restoring the dead to life, may also play a part in these responses.
Not infrequently euphoric responses are seen in those who experience a prolonged absence of conscious grieving; and they may also have experiences of depersonalization. Both are well illustrated in the account of an adolescent girl who had lost her mother reported by Wolfenstein (1966).
Ruth had just turned fifteen when her mother died suddenly from a cerebral haemorrhage. Shortly after the funeral Ruth found herself no longer able to cry. She felt an inner emptiness as though a glass wall separated her from what was going on around her.
At the time of her mother’s death Ruth had already been in treatment for six months (for reasons that are not reported). When coming for a session during the week following her loss she remarked, ‘I guess it will be pretty bad this week’, implying that she was expecting to feel distressed. Yet often she seemed the reverse. For example, on one occasion she appeared in an exuberant mood and explained how she had written a successful humorous composition in which she had congratulated herself on her performance at school and had transformed various embarrassing predicaments into comic situations. Each time she was in this sort of mood she hailed it as the end of her feeling distressed.
How precarious these euphoric moods were was shown by some of the dreams she had. In one, for example, she and her father were trying to escape from a disaster-stricken city but had then turned back to try to rescue the dying and the dead.
Several months after her mother’s death Ruth became depressed. She complained that nothing gave her pleasure any longer, neither being with friends, nor listening to music; everything she had formerly enjoyed had lost its savour. She felt she had nothing to look forward to, that any effort was too much, that all she wished to do was stay in bed. Often she felt like crying. For Ruth, however, none of this feeling was associated consciously in any way with her mother’s death. Instead, she berated herself for the senselessness of feeling like that; or else attributed it to her inability to be at ease with her schoolmates. Although the therapist tried repeatedly to help Ruth see and feel the connection between her feeling depressed and her loss, for Ruth this remained only an intellectual exercise.
Nevertheless, there were unmistakable signs of what her feelings were. Sometimes in bed at night, she said, she felt desperate with frustration, rage and yearning. On these occasions she tore the bedclothes off the bed, rolled them into the shape of a human body and embraced them. At other times she felt, when she was talking to someone, that she was not really addressing the person before her. When asked to whom perhaps she was talking, she said it might be her mother. But this seemed no more than detached speculation.
It was not until the second year after her loss that Ruth’s yearning for her mother began to emerge more clearly. Ruth had for long been overweight and her mother had repeatedly urged her to diet. Now she began to do so and after some months became surprisingly slim. On the eve of her birthday she went for a long ramble by herself and returned in a state of dreamy euphoria. But on the night of her birthday she started on an ‘eating binge’ which lasted many weeks. The explanation of this sequence only emerged later. Having conformed with her mother’s wishes over the dieting, it appeared she had been expecting her mother to return on her birthday: it was a bargain which had not been kept.
Yet, hopes of her mother’s return persisted. She felt as though she was constantly waiting for something. There should be an arrangement, she claimed, for people to be dead for five years and then come back again.
At length Ruth began to experience in full force her longing for her mother and her terror of losing her. As in other children and adolescents described in this and the preceding chapters, this experience occurred at times of separation or impending separation from her analyst. On one such occasion Ruth complained, ‘If my mother were really dead, I would be all alone’; on another, ‘If I would admit to myself that my mother is dead, I would be terribly scared.’ Eventually, four years after her mother’s death and at the time when she was going to transfer to another therapist, Ruth wrote to her therapist quoting the words of a cantata in which she was singing and in which the chorus voiced the desperate feelings of drowning children: ‘Mother, dear mother, where are your arms to hold me? Where is your voice to scold the storm away? . . . Is there no one here to help me? . . . Can you hear me, mother?’ This, she said, expressed exactly how she was feeling.
In her account of the case Wolfenstein gives few particulars of Ruth’s family, of the personalities or activities of her parents, of family relationships, or of Ruth’s experiences with her parents. Nor is it clear how Ruth was cared for after her mother’s death, though it appears that she lived with her father at least until he remarried three years later. (There is no mention of siblings.)
In so far as Ruth had referred to her mother in the sessions after the loss, she had done so in idealized terms, echoing in part, we are told, ‘what was being said in the family circle’. She was beginning to realize, Ruth maintained, what a remarkable woman her mother had been. She dwelt especially on an incident that had occurred during the year previously when she had been greatly distressed and her mother had been very sympathetic and understanding. In Ruth’s mind this image of her mother became archetypal of their relationship, and she ‘tended to gloss over the many real difficulties and frustrations in her life with her mother’. Yet of what these real difficulties and frustrations had consisted Wolfenstein says nothing.
The reasons for all these omissions are not far to seek. In presenting the clinical material Wolfenstein is intending to illustrate her thesis that, due to the primitive phase of their ego development, children and adolescents are unable to mourn. Since she is unconcerned with the alternative view which implicates adverse family experiences, no data relevant to that are given. Even the fact that Ruth had had emotional problems prior to her mother’s death of a kind that had led her to receive therapy is not referred to as being of relevance.
An alternative view is that Ruth’s responses are in no way typical of adolescent mourning, but are a pathological variant no different in principle to the examples of adults who experience a prolonged absence of conscious grieving described in Chapter 9. In supporting this view I would point especially to the following features of Ruth’s condition:
From these features, and drawing on the theories advanced in Chapters 12 and 13, I would infer a number of things about the way Ruth’s mother had treated her. First, I infer that as a rule Ruth’s mother had been brusquely unsympathetic towards Ruth’s desire for love and care, especially towards any distress or anxiety Ruth may have expressed about her (mother’s) absences. As a result of such treatment I would expect Ruth to have grown up knowing that sorrow and tears are rewarded not with comfort but with reprimands, that to be unhappy when mother is busy with everything but oneself is held to be babyish, silly or senseless, and that a bright, happy demeanour is what receives mother’s approval. Furthermore, I would infer that the image of her mother that Ruth was expected to hold was that of a capable woman who gave her daughter all the care that could reasonably be expected. Brought up in this way a child will naturally come to fear responding to a loss with sorrow, yearning and tears.3
The description Ruth gave of how she felt soon after her mother’s funeral is typical of the condition variously termed a sense of unreality, of depersonalization or of derealization: she felt an inner emptiness as though a glass wall separated her from what was going on around her.
Other examples of this condition, alternating, as in Ruth, with bouts of euphoria, are described by Fast and Chethik (1976). The following account, taken from their paper, illustrates vividly certain mental states experienced by a girl whose mother committed suicide when she was seven.
At the age of ten, three years after her mother’s suicide, Esther4 began a course of intensive psychotherapy which lasted for two years. At that time she was living with her father and stepmother. As regards problems, we are told that on occasion she was given to noisy overactivity which led to ‘intervention by those around her’. Reference is also made to her clinging to her sixth-grade teacher and dominating him by ‘her boisterous and turbulent behaviour’.
During therapy Esther described some of her fantasy life. Before going to sleep, she said, she was able to ‘will’ a special dream. This had gradually become embellished and currently took the following form. ‘She rose from her bed, floated above the house and ascended to a cloudy area where her mother was. Her mother appeared in a long shimmering robe bedecked with beautiful jewels, and was surrounded by a special glowing aura. In the background was her mother’s house on which was a sign “Here lives Miriam S”.’
Esther also developed a game in which she pictured herself as president of a large bank or corporation. She was much sought after, indeed indispensable, and always busy, and she amassed huge profits. Whilst playing at it during her sessions she would on occasion turn to an imagined crowd around her, bow deeply to her ‘fans’, clasp her hands high over her head and murmur ‘I’m great.’
As with Ruth, however, such sentiments were only skin deep. As therapy progressed Esther began to talk about feeling overlooked and forgotten. In the past this had led to her engaging in noisy overactivity; now she would often curl up on the couch and suck her thumb. She also found courage to describe how she had felt after her mother’s death. ‘After all the relatives had left and the funeral was over she had become very frightened. Everything in the house had begun to look like shadows. Nothing around her seemed real.’ She also remembered how, after coming home from school one day, she had stood alone in the house calling out ‘Mummy, Mummy, Mummy’, and how no one had answered. Her voice had seemed nothing but an echo. It was the most scary thing she could remember. Whilst recounting it to a comforting adult during therapy she sobbed intensely.
Throughout Esther’s treatment, it appears, issues regarding her relationship to her mother proved central. Amongst much else Esther described how after the suicide she had felt that her mother had abandoned her. She also felt torn between her loyalty to her mother and her tie to her stepmother.
In the original case report too little information is given about Esther and her parents to make much comment possible. Her mother, we can hardly doubt, had major emotional problems of her own and these had presumably had an adverse effect on the relationship between mother and daughter. A parent’s death by suicide moreover, also poses special problems, of which leaving the survivors feeling abandoned is but one. In the next chapter these problems are discussed further.
In Chapter 9 it was noted that among adults whose mourning takes a pathological course there is a minority who develop a sense of the dead person being in some way within themselves. Particularly striking are those cases in which the bereaved develops symptoms that are replicas of those from which the dead person had suffered. A number of examples of such symptoms occurring also in children are reported in the literature. Two have already been mentioned.
In the account in Chapter 19 of Henry, whose mother died when he was eight and a half, a description is given of how during a therapeutic session he suddenly held his hand to his chest and claimed he had a terrible pain and was having a heart attack. The pain he linked immediately to the operation his mother had had for breast cancer. This led on to his reminding himself of his mother’s insistence that he do his homework instead of coming to the clinic. It is probably relevant also that this episode occurred at a time when his stepmother was having a heart attack.
In the case of Addie, whose mother had died when Addie was four (this chapter), the stiff neck from which she suffered seemed clearly related to her mother’s death, though what relationship it may have borne to any of mother’s symptoms remains uncertain. Since mother had died of leukaemia and had also suffered injuries from father’s assaults, a stiff neck could well have been one of her symptoms.
Two other examples of young children developing symptoms that replicate those suffered by a dying parent, or grandparent, may be given.
Krupp (1965) reports on a boy, Paul,5 whose father had died suddenly of a cerebral haemorrhage when Paul was six. Shortly before his death father had complained of a splitting headache. Soon afterwards Paul, who had witnessed his father’s death, began also to complain of headaches, and for the next three years, during periods of stress, he would claim to be having a ‘splitting headache’, always using the same words. Subsequently, Paul developed many other problems, among them anti-social behaviour, a strong sense of guilt and a constant fear of retribution. No clues are given as to why he might have developed in this way.
A further example is drawn from an account given by Erikson (1950, pp. 21–7) of a small boy, Sam, whose paternal grandmother died when he was three. Grandmother, who was on an extended visit to the family, was not in good health and Sam had been warned to be gentle with her. One day Sam was left with his grandmother whilst mother went out. On her return mother found Sam with his grandmother on the floor having a heart attack. She lived only a few months longer, and died in the house. Despite that, Sam’s mother tried her hardest to keep the facts from him. In order to explain grandmother’s sudden absence she had told him grandmother had gone to a distant town; and an attempt had been made to explain away the coffin by a story about its containing grandmother’s books. Sam, it was evident, had not been deceived.
Five days after grandmother died Sam developed an attack of breathlessness during the night that was said to have resembled epilepsy. It was noted that before going to bed that night he had piled up his pillows in the way his grandmother had been used to doing to avoid congestion; and he had slept like her, sitting upright.
Many clinicians believe that unhappy children, including those who have been bereaved, are more prone to accidents than other children. Much circumstantial evidence favours this view, though I know of no epidemiological evidence that bears on it.
Of the bereaved children already described in this and preceding chapters, two sustained accidents during the course of therapy. Soon after witnessing the funeral of President Kennedy and making her first references to her mother’s funeral Geraldine fell in the gym and broke her leg (Chapter 19). Shortly before he was due to cease seeing his therapist Seth fell from a windowsill on to which he had climbed and broke his elbow. This six-year-old boy, it will be remembered, had been present when, two years earlier, his mother had fallen out of bed and been unable to get up.
Another child who sustained a fracture, in this case on a significant anniversary, is reported by Bonnard (1961). (In the original record this boy is referred to as John. Changing the name to Jack is to avoid duplication with the one-year-old referred to in Chapter 24.)
For some months Jack, now aged nearly thirteen, had not been attending school and for this reason was referred to a clinic. On investigation it turned out that he had also been pilfering housekeeping money from home for at least a year, though this was not known to the school. Until these difficulties began he had had the reputation of always being a well-behaved and reasonable boy.
Ten months before being seen at the clinic and when Jack was aged twelve his mother had died of carcinoma of the breast. She had had a mastectomy five years earlier; and during the ten months prior to her death she had been in hospital after a fall in which she had broken her thigh due to the presence of secondaries. Father had not been told of the fatal nature of the illness until the final five weeks. Jack had been kept in the dark until he had heard by chance shortly before she died.
Jack was one of three living children in a close-knit family. There was a brother four years older than him and a sister nine years younger who had been born a year after mother’s mastectomy. In addition, a baby had been born a year before mother’s operation but had not lived.
During interviews with father and with Jack it became clear that each was bitterly critical of the other. Father was in a state of fury and despair over his son’s behaviour and had visions of him growing up to be a criminal. Conversely, Jack complained that his father had let his wife do everything in the home and for the children and had then grumbled at her. Now, he went on, father was simply spoiling the little girl who, amongst other things, shared his bed. For some months Jack had been doing much of the family cooking.
Ever since his mother died Jack had been bitter about having been kept in the dark about her illness and he was still much preoccupied about who or what might have been responsible for it. One idea was that after the baby had died his mother’s milk had been left unused and had gone bad. Another, probably derived from his having overheard relatives talking, was that father was at fault for having made mother pregnant again so soon after her operation. As regards the fracture, he first blamed the dog because it had led her to lose her balance, and he next blamed the rest of the family, which of course included himself, for having lain abed and allowed mother to bring them their early morning tea even when she was unwell. It then transpired that on the first anniversary of mother’s fall Jack had himself fractured his elbow.
Two features that stand out in this case are, first, the silence about mother’s true condition with its attendant uncertainties about causation and, secondly, the strong tendency for each member of the family to direct blame either at other members or towards the self. The fact that Jack’s accident had taken place on the anniversary of what, for him, was probably a crucial event in his mother’s fatal illness, and about which all surviving members of the family had evidently felt much guilt, could hardly have been a coincidence.
From the relatively few cases on record it is not easy to identify what the precise conditions may be which result in certain children and not others either developing the same symptoms as a dead parent or sustaining an accident in circumstances that have a close connection with the parent’s illness or death. The most that can be said is that in all the cases referred to here mourning was following a pathological course. In most of them the child had been present when the parent who subsequently died had suffered a severe attack of pain or an accident; and in most, too, there had been a great deal of attempted secrecy. Issues of blame were prominent also; and it may be that in all of them the child was in some degree blaming himself for the catastrophe. Nevertheless, frequent though all these conditions seem to be, each of them can occur also in cases in which the children do not develop in these particular ways so that none can be regarded as pathognomonic of the disorders in question.
Where a child or adult develops symptoms that are replicas of those suffered by a person who has died it is obviously convenient to refer to them as identificatory. As an explanation of why they should have occurred in certain individuals and not in others, however, this designation does not take us very far. Nor does it indicate in any clear way what the psychological processes at work may be. Fortunately for purposes of treatment our lack of understanding is no great handicap, since once the disorder is recognized as stemming from failed mourning the therapeutic task is clear.
The same is true in cases of accident. In some of them, and perhaps all, a major motive at work is a desire for reunion with the dead parent, associated more or less consciously with ideas of committing suicide. As we saw in Chapter 17 and also earlier in this chapter, these ideas are certainly prevalent in individuals, whether child, adolescent or adult, who have lost a parent during childhood.
In this long chapter an attempt is made to illustrate how a large variety of psychiatric disorders can be understood as being the responses of children to the death of a parent when the death is preceded by, or is followed by, certain specifiable conditions. For some disorders the causal connections are plain to see; for others they are more obscure even though discernible in outline. In regard to all of them more research is needed.
In the past far too little systematic attention has been given to the power of these environmental variables to influence the course of mourning. This has left the field clear for such traditional hypotheses as phase of development or autonomous phantasy. What we now know is that the more clearly the relevant conditions are specified and the more careful the investigation the more regularly are they found. With our present knowledge, therefore, I believe the only safe assumption for a clinician to make is that in every case, behind the smoke of a child’s anxiety, self-blame or other symptom or problem, there burns a fire lit by some frightening or guilt-inducing experience of real life. In no situations are these sequences shown more clearly than after a parent has committed suicide.
1 The case report does not say who took Addie to the grave. Since grandmother was strongly opposed to the idea, it seems likely to have been the therapist.
2 In Root’s account the patient is not given a pseudonym; the pseudonym used here is for convenience of exposition and reference.
3 The theory of adolescent development that Wolfenstein assumes in her 1966 paper is one that unwittingly tends to encourage the idea that an adolescent developing compulsive self-reliance (or a ‘false self’ in Winnicott’s terms) is developing satisfactorily. For example, tears are identified as regressive; and it is believed that during normal development an adolescent ‘is forced to give up a major love object’ and that ‘developmental exigencies require a radical decathexis of the parents’. This view of adolescent development as requiring a radical withdrawal of attachment from parents derives from dependency theory and is still widely held. As I show in Chapter 21 of the second volume it is not supported by the findings of empirical studies.
4 In the original this child is given the pseudonym Ruth which has been changed here to avoid confusion with the previous case. Virtually no information is given about the family relationships, the circumstances of mother’s suicide or the reasons for Esther receiving treatment.
5 A pseudonym has been given this boy for ease of reference.