Teens & Grief

5. The grieving process is influenced by many issues.
The impact of a death on a teen relates to a combination of factors, including:
- Available social support systems
- Circumstances of the death (how, where, and when the person died)
- Whether or not the youth unexpectedly found the body
- The nature of the relationship with the person who died
- The teen's level of involvement in the dying process
- The emotional and developmental age of the teen
- The teen's previous experiences with death

6. Grief is ongoing.
Grief never ends, but it does change in character and intensity. Many grievers have compared their grieving to the constantly shifting tides of the ocean: ranging from calm, low tides, to raging high tides that change with the seasons and the years.

The "never-ending, but changing" aspect of grief may be one of the least understood. Most people are anxious for teens to have closure and "put the death behind them" so that they can go on. But death leaves a vacuum in the lives of those left behind. Life is never the same again. This does not mean that life can never be joyful again, nor that the experience of loss cannot be transformed into something positive. But grief does not have a magical closure. People report pangs of grief 40, 50, even 60 years after a death. Grief is not a disease that can be cured, but a process we learn to incorporate into our lives.

How Different Types of Deaths Impact Teens.

Often teen friendships are up and down, on and off relationships. Grief complicates all relationships and ends up pulling people together or apart. After the death of a friend, some teens draw together to share their grief, while others are embarrassed and have difficulty sharing emotionally-charged grief. It is common for teen friendships to revolve around fun. Grieving is not fun. The grief that follows the death of a peer is compounded by the added loss of peer friendships and fun times.

Trust is built with teens by telling them the truth about how, when, and where a peer died. Secrecy, deception, half-truths, and lies, even when intended to protect, will often backfire, creating a wedge of suspicion and anger. Teens need to know the truth and should be trusted with the truth. If you don't know the facts, then "I don't know" is the truth.

The Death of a Parent
The death of a parent is usually a devastating, distressing experience in the life of a teen. When a parent dies, a young person's sense of security and stability in the world is turned upside down, regardless of the nature of the parent-child relationship. A parent's death disrupts the teen's life with radical complications. Suddenly the teen is different from peers and feels strange and alone. The death of a parent becomes the defining event in the teen's life. A teen begins to define his or her life in two categories: "before" or "after" the death.

Teens who have conflictual, even abusive, relationships with parents may experience a sense of relief, ambivalence, guilt or regret after a parent dies. An abusive or neglectful relationship compounds the distress because the death means the loss of hope and opportunities for restoring the relationship.

Often financial and daily living circumstances change radically when a parent dies, increasing the teen's feelings of instability and loss of control. Teens may have concerns about immediate physical and financial security. A parent or other adult can help by discussing the family's financial status, decisions, and plans for the future with them. Telling the truth and giving choices will assist grieving teens to regain a sense of control of their lives.

Grieving teens are also coping with the realization that they will not have a father or mother to celebrate rites of passage. You can help them by recognizing that those events will be difficult times without the parent. As those events approach, it is important to help teens consider creative ways to memorialize the deceased.

The death of a parent means the beginning of new life with a vulnerable, grieving parent, even if the parents were divorced. The teen left with only one biological parent is often also concerned, consciously or unconsciously, with the possible death of the surviving parent.

Sometimes the remaining parent places unrealistic expectations and roles on the teen to take over parental functions. Or, sometimes the teen takes on these roles with no prompting from adults.

The Death of a Sibling
The death of a brother or sister is significantly different from the death of a parent or another adult caregiver. Siblings are peers and experience a unique attachment as children of the same parents. Often siblings hold confidences for each other from the parents. Suddenly in many families the surviving child is "an only child" in a complex way that requires an unwanted adjustment of roles and relationships.

A Violent Death
When teens experience a violent death such as a murder, a drunken driving crash, or other violent act that leads to death, their basic belief system is thrown into turmoil. Teens typically consider themselves and their families immune from such violent acts. Suddenly their innocence and certainties are shattered and their world no longer feels safe. Thoughts and feelings about the person who died and the person(s) who caused the death get mixed up and teens feel confused. Revenge and animosity toward the perpetrator can get in the way of truly grieving for the person who died.

People often harshly and unfairly judge the victims or their family after a violent death. This helps people protect themselves from believing that someone they love could die violently. People feel safe if they think that "bad things only happen to bad people." Obviously, this attitude alienates those who are impacted by a homicide or violent death.

After a violent death people's curiosity and questioning can be intrusive and irritating to many teens. The initial media exposure may be sensationalized, promoting conjectures or outright errors that are never retracted or corrected. Sound bites and video clips don't give a significant explanation of what happened. Anger, resentment, bitterness, and frustration mount for the grieving teens not only toward the perpetrator but toward others in the community who rush to conclusions based on incomplete, and often inaccurate, information.

Another factor that may make coping more difficult after a violent death is the impact of the ongoing legal investigation and, potentially, a trial. Family members are told by police not to discuss the case with anyone, which makes it difficult to get support. Sometimes a family member is a suspect, which adds intense stress on everyone. Because of the time lag between the violent act and the verdict, many supportive persons move on with their own lives and are unable to support the family. Sometimes victims feel alone, forgotten, and isolated.

Death by Suicide
The act of suicide produces an array of unwanted thoughts and feelings toward the person who died and about the circumstances under which the death occurred. "Why?" seems to be the foremost question for teens who have had a friend or family member die from suicide. Thoughts of unfulfilled promises, disrupted relationships, missed warning signs and haunting unanswered questions relentlessly preoccupy the teen's mind. Real or imagined images of the final scene may persist and cause emotional turmoil.

Teens may be afraid that they are "fated" to die by suicide when a parent takes his or her own life. It is important to assist teens in understanding and developing other ways to cope with life's inevitable disappointments and difficulties. Teens also have a strong desire to understand and make meaning of the suicidal act. Because of society's general lack of knowledge about contributors to suicide, teens may have differing views about why the person died, and may even blame themselves. It is important to help them understand that suicides occur when a person's brain and thought processes are not working properly, much as liver disease may result when someone abuses alcohol, or heart disease when someone neglects their body. The diseased brain determines that suicide is the only escape from pain. Additionally, schools or communities, in an attempt to deglamorize suicide and prevent copycat suicides may discourage mourning or memorializing the person who died. This failure to acknowledge the life of the person may actually reinforce the survivor's alienation and support the suicide's belief that their life was no longer worth living. There are ways to acknowledge the life and death of a person who suicided without glamorizing the act itself. It is an opportunity to educate around warning signs and prevention that may be lost if schools choose to remain silent.

Multiple Deaths
Two types of multiple deaths may complicate the grieving and healing process for teens. Multiple deaths in a single incident like a car crash or school shooting may add an additional level of complexity to processing why such events occur, part of the necessary "meaning making" task of teens. A succession of deaths during a short period of time may also lead to bereavement overload, and a fear that no one is safe. Additionally, for teens involved in an accident or incident where others died and they lived, it is not uncommon to see "survivor guilt" among those whose lives were spared.

Death from AIDS
It has been our experience that teens who have had a parent or sibling die of AIDS usually feel uncomfortable talking about the cause of death due to the social stigma associated with AIDS. Teens may fear that if they do reveal that it was an AIDS-related death that they will be ostracized. Teens may also fear that people will judge them or their family through a perception that the death was "deserved" because of promiscuity, homosexual behavior or drug use. Because young people in this situation tend to hold their feelings inside, they may experience a higher level of physical symptoms and concerns about their own health.

Don't force the teen to share the cause of death with others unless and until he or she is ready to do so. At the same time, allow the teen to talk about the person who died and to memorialize the deceased. Once the teen is ready to discuss the cause of death, you may want to help him or her gain a thorough understanding of AIDS and to think through how to respond when someone is critical about the disease. Finally, teens often benefit from participating in support groups with others who have experienced an AIDS death.

Death from Chronic Illness
When a family member's death is due to illness, teens sometimes develop fears around their own health, worrying that they too have the fatal disease or illness. After such a death, teens want to share common experiences around the dying process. They want to talk about things like hospitalization, medical procedures, emergencies, changes in personality due to an illness, and how illness affects relationships. Teens may also feel a sense of relief that the person died because the intense suffering and pain is over. This sense of relief, which may bring on more guilt or other accompanying feelings, needs to be normalized.

Accidental Death
Death from an accident often evokes fears around lack of safety, loss of control, powerlessness, and unpredictability. Accidental deaths may occur in a variety of circumstances including car accidents, work-related injuries, sports-related accidents, etc. Teens need to share what they have been told about the accident and what they think actually happened.

When a Teen Witnesses a Death
Witnessing a scene where someone dies or being threatened by a person or situation can result in stressful emotional and physical responses. It is especially traumatic for a teen to find the body after a murder or suicide. Being on the scene during emergency medical treatments can also be traumatizing. These incidents have dramatic effects on the mind and body of the young witness. Allowing the witness to express thoughts and feelings about the traumatic incident helps reduce its negative effects. Recounting the unfolding drama of the event and discussing his or her own perceptions helps the witness diminish the aftermath of the traumatic event.

In some cases, young witnesses should see a professional for a crisis debriefing and evaluation. It is possible for teens to experience a delayed psychological and physical reaction to a horrific event. Without some intervention, a teen may develop a post-traumatic stress disorder. Although the reaction may be delayed, the symptoms of this disorder result in future complications to the teen's normal lifestyle. Delinquent behavior may be one expression of this disorder.

Because teenagers are entering the phase developmental psychologist Erik Erickson refers to as "formal operational," their major focus is on establishing independence. Experiencing the death of a family member or friend complicates their struggle for identity, and they may pull away from parents and adults toward reliance on peers for what to think and how to act. The way adults can be most helpful to them as they journey through their grief process is to provide non-judgmental safety and assurance as they struggle for meaning. Pushing them to perform or act a certain way will likely push them away. Let them know you are available, and don't approach them as someone to fix or repair, but rather, allow your calming presence to support them in their feelings, whatever they are. If necessary, intervene when destructive behaviors emerge, but otherwise allow them to feel the pain, anxiety, and confusion, and to express it, or not express it, as they choose. If they trust you are safe and caring, they will allow you to walk with them as their grief journey unfolds.

Donna L. Schuurman, Ed.D., is the Executive Director of The Dougy Center for Grieving Children in Portland, Oregon. She serves as President of the Board of Directors of the Association for Death Education and Counseling and is writing a book for adults who had a parent die in childhood.

Amy Barrett Lindholm, M.S., is Coordinator of Children's Grief Services at The Dougy Center and previously worked at Oregon Health Sciences University in the area of adolescents and depression.

This article is condensed from Helping Teens Cope with Death. A guidebook from The Dougy Center. It is used here with permission from The Dougy Center (www.grievingchild.org).