The Oates Journal (ISSN: 1098-1446) is a publication of the Wayne E. Oates Institute addressing issues related to spirituality, ethics, and healing from the perspective of pastoral care and counseling.

Hindsight for Tomorrow Series

A Neglected Majority:

Parents Bereaved by the

Traumatic Death of their Child

by Ronald C. Oliver, Ph.D., BCC

Assumptions

When I began interviewing parents grieving the traumatic death of their child I was utterly naïve about the depth of their pain. The original goal for my dissertation was to assess the effects that an acute traumatic crisis had on a person's faith, i.e., their meaning-making. Bereaved parents were to provide the "experience set" to examine the phenomenon. However, as I experienced their stories, my research goals and my life changed.

A dad shares his experience of going to his son's side just after a car hit him.

The impact threw Michael about one hundred feet down the road. He was laying on the ground, on his side, his legs were broke--I could tell that. And, I was scared, you know. I was panicked then, but I looked at him and I could tell, you know. His eyes were open like he was crying but he wasn't making no sounds or nothing; he was just laying there, tears was coming out of his eyes.

Lee's mother talks about her life after a car hit her son.

It eats at you . . . it's been eating at me for the last three years. . . . It gets worse. I, I feel worse everyday. It gets harder to deal with it more everyday. And I always felt like, you know, everybody said, 'Okay, well, just give it some time. Give it time.' And I'm like, 'Damn, how much time does it take?' . . . I keep telling myself [that] one of these days I'm hoping that I'm going to wake up and I'm going to feel better and I'm not going to feel like this. I'm not going to feel so depressed all the time. You know, I'm not going to feel like getting up and blowing my brains out one day and then I have to stop and realize, 'I've got kids. I can't do this.'

These accounts are not anecdotal, they are the norm. We exchanged gifts over their kitchen tables. They gave me their story; I gave them a hearing. We both benefited. A mother whose son had died seven months before the interview told me, "When I got that little letter requesting a visit in the mail from you, I was so glad. I think that I was getting to the point where if I didn't talk to somebody, I was just gonna be lost forever." While each story revealed truth particular to its storyteller, the collective stories yielded collective wisdom. The sacred expanse of each parent's experience refused to fit into the research box I had crafted. Their stories compelled me to lean forward and listen.

Lessons

As my colleague Chaplain Terry Tatro stated it, "to dodge is like a dagger." I've heard so many bereaved parents share variations of the same story: they're in a store, someone they know starts down the aisle toward them, sees them, turns around and goes another way. Parents experience a secondary loss when potential caregivers and supporters avoid them. Some supporters pull back because they can't fix the situation. When supporters feel they must relieve parents' pain they create an unobtainable goal. Beneficial care is embodied in those people who can stand still in the pain in order to create a sanctuary where parents can be and say what they must. The bereaved will more readily forgive those who offer well intentioned but insensitive care, than those who do not bother or are too afraid to care. In this instance, the fear or anxiety experienced by the caregiver will never be greater than the fear and anxiety experienced by the bereaved parent.

SIDEBAR #1

The care of bereaved parents is a marathon, not a sprint. Every bereaved parent has heard it, "You should be over this by now." "You should take the pictures down." "When are you going to get back to normal?" A year after the death of their son, John, the dad, said,

We stopped visiting the grave, not because we wanted to stop, but because people started talking and all, saying, 'Maybe you shouldn't go so much.' We've stopped doing things that remind us of Michael because it just causes a problem with our family and friends.

When a child dies traumatically, shock, that constellation of physiological and psychological responses designed to hold terrible news at a manageable distance, can last for six, eight, or even twelve months. Looking back on the accident in which her son was killed a year and a half before my interview with her, Linda said,

I still feel like, I feel like I'm in a daze. I feel like time has stood still in a sense. . . . I still feel like I'm frozen. . . . I'm so in shock. Did this really happen? You know, is he really gone forever? It's like, well, what happens now? What am I supposed to do? How am I supposed to feel? I can't go on without him, but yet I can't kill myself. . . . If I could, I would. I would do it.

More often than not, a prolonged shock reaction is normal. We wish parents would hurry up and get over it. The secret is, they want the pain to go away too! However, some things take time to work through and the big griefs are among those things. Alice Demi & Margret Miles (1987) co-authored a Delphi study in which they asked twenty-five bereavement experts to express their opinion regarding the appropriateness of thirty bereavement behaviors at 1, 6, 12, 24, and 60 months after a death (see Table 1). Their survey covered two of the areas supporters often have concerns about--the frequency of parents visitation of the grave and how quickly parents disassemble the child's room (usually the younger the child, the greater the pressure to dismantle the room).

TABLE 1

Thus, at twelve months only 48% of these experts are concerned about the survivors who leave the deceased room intact. At twelve months only nineteen percent of the experts report concern about regular visits to the grave. While I agree that opinions vary among experts, the point to be made is that normal grieving will very likely go on for a long time. The greater the grief, the more time will be required to do the work of grief. That's normal and that's okay.

One harsh example from a recent interview comes quickly to mind. A couple of months after her baby died suddenly and unexpectedly the mother called a close friend who coincidentally is a psychotherapist. After bearing her soul the friend-therapist responded, "Listen, shit happens. You're going to have to get over this." The "friend" then ended the conversation. Mom was crushed. The call for help had been rejected and she felt both discounted and humiliated and even less eager to ever share herself again. Bereaved parents too often are compelled to separate themselves from anyone who imposes unrealistic expectations on the pace of their grieving. Often the only people who understand are other bereaved parents. In the presence of each other they extend grace to wonder, get cussin' mad, cry—all without any admonition to get over it.

SIDEBAR #2

Community makes the critical difference. On a cold January day while driving north on Interstate 65 just after a terrible ice storm, I took notice of the devastation inflicted on the trees at the forest's edge. Hundreds of the trees nearest the interstate had fallen under the weight of the ice. Interestingly to me, only trees at the forest's edge fell while the mass of the forest remained standing. What made the difference? The trees that could distribute the weight of the ice among their neighbors could collectively bear the weight that brought down an individual tree. Their intertwined branches and roots anchored them into a mutually dependent relationship and thereby assured their very survival. The trees pushed away by wind and ice from the natural support of their forest friends, fell down. As goes the forest, so goes the tree.

SIDEBAR #3

When a child dies, most often the parents who do okay will credit the core group of people who formed around them for the long haul to help get them through. When the weight of the storm bears down, the parent who is caught by the long term supportive branches of understanding supporters can survive the storm. The parents who lack this support may, like the lone tree, fall. As goes the community, so goes the individual.

A mother whose young son was hit by a car told me about the day her friends came to her aid,

For the months after Ryan died I just stayed in my house. I didn't go out unless I just had to. I didn't want to see nobody. One afternoon there came a loud knock on my door and a choir member from my church said, "We're here to see you." I said, "Go away. I don't want to see anybody." She said, "You've been here long enough, we won't let you stay here any longer." And then they carried me out.

This mom went on to describe what "carried me out meant." The friends made her leave the house—they dragged her out of her house. She looks back on that day with gratefulness. That was the day that her friends risked themselves to boldly enter her experience and care for her.

During my interviews with bereaved parents over the years I have met so many who have given up on church—not just their church, but all organized religion. Most often parents cite the failure of their community of faith to live up to the explicit and implicit promises they made to care for the parents. While care usually starts off strong, it can have a short shelf life. Wayne Oates noticed how this could happen:

The community rituals fade out as the family members reinstitute their daily routines and the crowds of comforters "thin out." This sudden thin out, however, may well trigger an emotionally "toxic" reaction. Up until now, the family has been overwhelmed with attention and care, to the point that they find it a drain to continue responding, talking, saying thanks. Beyond this thinning out point the family may begin to suffer from undernourishment and lack of care. The strategy of the pastor is to 'see to it' that a balance is maintained. (1976, p. 73)

The erosion of the support network can be a deceptive process. Supporters can feel like no care is required because they left with the parent the invitation, "Call me if you need me." The truth is that few of us in our pain will ever do that and even fewer parents possess the will to call for help at a time when they are emotionally depleted and filled with the temptation to withdraw from all but requisite relationships. In the care of bereaved parents, the initiative for care always rests with the supporters.

I recently interviewed a couple whose teenage son had died four years prior. The couple had been very active in their church—both held positions of leadership. After their son died in a freak accident, church members poured forth support—meals, calls, people in the home—for about two weeks. After that, virtually nothing. They stopped going to their church, no one called to see why. When church members stopped by the father's office at the bank where he worked as a vice-president to ask him when he was going to come back to church he shared with them how angry he was for being abandoned by them. Nothing changed. One day dad came home glad to see the youth minister's vehicle in their driveway. Dad told me what he thought, "Finally someone has come to check on us." As it turned out, this minister had stopped by because he wanted some advice because he was facing a surgical procedure similar to one undergone by this father. The father complained, "He never once brought up my son. He never once asked us how we were coping." These parents rejected all religious communities because, right-or-wrong, they felt rejected by what had been their religious community.

A Response

Given the profound needs of bereaved parents I established a Bereavement Intervention Program (BIP) at Kosair Children's Hospital (Louisville, Kentucky, USA) for parents whose children die from a traumatic accident. In 1994 the Children's Hospital Foundation provided $4,500.00 and in 1997 a $48,250.00 grant from the Norton Healthcare Community Trust Fund continued and expanded the program. The goals of the BIP initiative are:

1. Assist parents while their child is a patient. To meet this goal, the hospital has established the policy that chaplains are called for every death and we 'shepherd' the care of the parents and the disposition process.

 

2. Visit parents at the funeral home to express condolences, answer questions, and describe future initiatives. Parents are often shocked when the chaplain arrives at the funeral home. When this unexpected initiative is taken it signals to the parents that our interests in them extend beyond the boundaries of the hospital campus.

 

3. Visit parents in their home 2-4 months after the death to assess grieving patterns, link them with support groups and counselors, and educate their friends and family in ways they can assist the bereaved parents. This is the heart of this initiative. After visiting the parents, the chaplain, parents, and 15 supporters, i.e., people parents count on for care and understanding meet at a local restaurant. After the meal (which is paid for by the grant), the chaplain talks with these supporters about ways they can help the bereaved parents. At this meeting four needs of bereaved parents are discussed: 1) the importance of talking about and remembering the child; 2) the significance of having realistic expectations for a parent whose child has died; 3) the requirement that the supporters remain committed "for the long haul" to the parents; 4) what care looks like—specific actions that supporters can take to help bereaved parents.

 

4. In 1999-2000 the attempt was made to revisit all the parents of children who had died traumatic deaths 1995-1998. The goal was to assist them as needed and to more specifically assess the effects of the child's death.

Several assumptions underlie this initiative. First, the people that parents live with are best positioned to help them. Second, the supporters will likely be highly motivated to help and therefore are likely to be receptive to learning new helping strategies. Third, care of the parents can be improved if common cultural myths about grieving are addressed. Fourth, and perhaps most notably, this program owns the initiative for taking the care to the parents and it seeks to "commission" the supporters to do likewise.

The appreciation of this program by parents and supporters has been almost unanimously positive. As well, the BIP was discussed in Hospitals & Health Networks (January 1999, p. 20), presented as a concurrent workshop at the 1998 Annual Conference of the Association for Death Education and Counseling, and, just recently, was described and discussed in a plenary presentation by Mary Fallat, M.D. (Director of the Kosair Children's Hospital Trauma Service) in October, 2000 at the Annual Meeting of The American Association for the Surgery of Trauma. (The October, 2000 presentation has been submitted for publication in the Journal of Trauma.)

Final Thoughts

It was like I'd think, if I was like a little music box dancer, if somebody could just take me down from the shelf and just wind it up and just let me dance for a few minutes so I could feel like I once felt--have that uninhibited joy, because sadness now stands alongside the joy. And, just to know again the gaiety, the spontaneity, all those things that I once felt. I still long for that. And it will never be. And, I think if just for a minute I could feel that. You know, that is really forever gone. It gets better and it gets better, but it will never be. It's just... there is life before and there is life after.

--Diane Spear, mother of 15 year old Mark
who died in a motor vehicle accident

After the first year of life, more children die from trauma than all other causes combined. The numbers are staggering. These parents' needs are widely misunderstood and overlooked. Pastoral caregivers must lead the campaign to understand parents' experience and to equip parishioners as initiative taking, community-sustaining care providers.

References

Demi, Alice S. and Miles, Margaret S. (1987). "Parameters of normal grief: A delphi study," Death studies, 11:397-412.

Oates, W.E. (1976). Pastoral care and counseling in grief and separation, ed. Howard J. Clinebell. Philadelphia: Fortress Press, p. 73.

Suggested Readings

Klass, Dennis D. (1999). The spiritual lives of bereaved parents. Philadelphia, PA: Brunner/Mazel.

Oliver, R.C. and Fallat, M. (1995). "Childhood traumatic death: How well do parents cope?" The journal of trauma: Injury, infection, and critical care. Vol. 39, No. 2: 303-308.

Rando, Terese ed. (1986). Parental loss of a child. Champaign, IL: Research Press Company.

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