Articles by Dr. Silverman

When Parents Die

From "Living With Grief: Children, Adolescents, and Loss"
Edited by Kenneth J. Doka

This article describes some of the factors to consider in understanding children's reactions to the death of a parent. Any intervention that might be offered to help bereaved children and their needs to be responsive to these realities in the bereaved child's world. We need to match any help offered to what the bereaved are actually experiencing, to their resources, and to the social context in which they are living.

Findings from the Harvard/Massachusetts General Hospital Child Bereavement Study provide the data for this paper. The Child Bereavement Study at Harvard/MGH examined over time the impact of a parent's death on children ages six to seventeen. Both children and their surviving parent were interviewed, in their homes, approximately four after the death, as well as one and two years later. A community sample from the greater Boston area, 125 children in 70 families, was recruited through the funeral directors who served them at the time of the death. Interviews with respondents were audio taped and included many open-ended questions, thus allowing them to tell their story in their own words (Silverman and Worden, 1992, 1992a, 1993; Worden and Silverman, 1993, 1996; Silverman, Nickman, and Worden, 1992; Silverman and Nickman, 1996; Normand, Silverman, and Nickman, 1996; Nickman, Silverman, and Normand, 1998; Silverman, 2000).

Factors to Consider in Understanding Children's Reactions to the Death of a Parent
Grief as a transition, not an illness

In talking about grief in children or in their surviving parents there are many ways of understanding what they are experiencing. In fact, there is no right way or wrong way to grieve. Sometimes it is to cope with the situation if we have a theory that explains the experience. One approach that until recently has dominated our thinking looks at grief as primarily an inner psychological phenomenon. The feelings of sadness, of confusion, of longing, and the anxiety about the vacuum in one's life are seen as something to be expunged as quickly as possible. In this view, grief is seen as an illness, and the negative consequences of this illness can be prevented by helping the child express his or her feelings. People who see grief this way talk about "recovering" and "bringing closure" to the experience within a limited period of time. If the child doesn't do so, they are seen as being at risk of developing serious emotional problems. In many ways this view is often with the actual experience of bereaved families. They find that there are too many other things happening as they struggle with the loss and its impact on their lives.

In another view, grief is understood as a life-cycle transition, albeit unexpected given the family's place in the life cycle. This view focuses on the broad range of issues and tasks that the surviving parents and their children have to attend to as they move in time away from the death (Baker and Sedney, 1996; Silverman, 2000). When viewed as a life-cycle transition it is easier to see that grief is more than the expression of extreme feelings. More than a life is lost when a parent dies. Not only has a person died but a way of life is lost as well. The self they were in this relationship is also gone. It is a time of loss and change in the family's life. The goal of help is to enhance the mourner's ability to find ways of living in this moving, changing situation.

One of the findings of the Child Bereavement Study is that grief does not end at a given time (Silverman and Nickman, 1996; Silverman 2000). It is not something that children can simply put behind them or "get over." The bereaved, both the surviving parent and their children, often feel isolated, as if something is wrong with them, when their experience does not coincide with the advice they are given to "seek closure," to "put the past behind them," or to "let their grief go." A mother of teenage boys reflected on how she felt a year after her husband's death:

People keep telling me I will feel better, the children will return to normal. I wondered what was wrong with me when nothing was the same as before. What was I doing wrong? I finally realized that everything was different-we would be okay, but never like before. I stopped talking to most people. They didn't want to hear about our pain, about the ups and downs and all the changes we were dealing with.

In fact, as children mature and as a result of their experience, they develop a greater depth of understanding of the death. An eleven-year-old reflected on how he has changed:

I didn't think I would ever feel better, I couldn't concentrate or think about anything. I thought the world would end without my mother. I wouldn't talk to anyone. I can't believe that one year later, I still miss my mother and I feel sad but I can study and I'm getting along with my friends. I'm lucky they stayed with me.

Children will revisit the meaning of their parent's death many times over their lifetime. They will experience the loss in different ways at various stages and phases of their lives, such as graduation, marriage, or the birth of a child. This is not an expression of unresolved grief. Their accommodation and adaptation is a dynamic, ongoing process.

Children are often facing, for the first time, the fact that people die. To some extent children lose their innocence and the expectation that their parents can protect them from all the vicissitudes of life. They need to learn to make room for this fact of life in their experience. They need to learn to deal with unusual feelings with which they have had little experience, and to live in a world that has changed for them in ways that they could not have imagined.

Life does not stop while they deal with their feelings and sort out what is happening. The family has to find continuity with the past while constructing new ways of living together in a single parent bereaved family with a changed family system. They need to develop a new sense of what is normal, given the changed circumstances.

Children do not grieve alone. Children are part of a family, all of whom have been affected by the death. One mother observed, shortly after her husband's sudden death, that every time his father's name was mentioned her nine-year-old ran into his room:

He hid under the bed and who could blame him, I was ready to join him there. I guess I looked okay on the outside, I needed to be there for the children, but if someone could see inside, they would feel the tumult, the terror.

The family that both the children and their surviving mother or father once knew is gone. A way of life is lost. In the words of a thirteen-year-old girl, "I couldn't imagine how we would get on without my father. Nothing seemed right." One father felt as if he were in someone else's house. Another mother talked about her fears:

Everything changed. They had gotten used to his being there after school since he couldn't work anymore. My husband was a nurturer and he really enjoyed listening to all the day's news. I wasn't sure I could handle it alone. He gave me balance and a bit of humor. That's gone.

The gender of the surviving parent makes a difference. Men and women, not invariably but often, approach their grief in somewhat different ways (Silverman, 1980, 1988; Cook, 1988; Worden and Silverman, 1992; Silverman and Worden, 1993; Silverman, 2000; Martin and Doka, 1998). In considering the effects of the death of a parent, differences in terms of the roles of mothers and fathers in the family need to be considered as well (Boerner and Silverman, 1999; Silverman, 2000). Women seem to relate more to the emotional needs of the family and are more responsive in providing children with support and care. Even when the women worked and fathers were accustomed to helping in the house, in this study population, women were the ones who cared for the emotional needs of the family and made the house into a home. Most children reported that they were not used to talking to their father about the details of daily life or confiding about their friends. This was most often the role their mothers played in their lives. In most families where the mother is the surviving parent there seemed to be fewer changes in the family's daily routines (Silverman and Worden, 1993). In the words of one mother, "I just went on doing what I always did-not much changed in that sense."

Several mothers, in anticipation of their own deaths, recognized their husband's limitations in nurturing their children and advised them to remarry so the children would have a mother. Yet fathers did rearrange their lives to care for the children, taking jobs that were closer to home or that had less demanding hours. Many fathers recognized that they had a good deal to learn about parenting. One father talked about his twelve-year-old son. His older children were grown:

I had a lot to learn. I wasn't sure I could do it. He was so close to his mother, her baby. We've come a long way. We now talk, we do things together. I'm here for him and we are managing. He's doing good in school and he has lots of friends who he brings home.

Women, too, have a good deal to learn about keeping the family together and keeping the household going. They need to learn to parent alone. Many of the women in this sample had lived with their parents until they married. The mother of a school-age child and a teenager talked about her concerns:

My husband knew how to take care of all the little things in the house. He was always there to back me up. I don't know how I can be alone. I think there is always the worry: Can I hang on to the house? Am I going to raise my kids well enough? Can I get a job with mother's hours and health insurance to carry us through so I can be with the children as much as possible?

Whether it was mother or father who was the surviving parent, at some point after the death both had to come to the realization that they had to learn to be a single parent and this job required new skills. The content of what they needed to learn was not the same, depending on their role in child care in the family before the death. It is not simply gender that made the difference in what was lost for the family with the death. There was no longer a division of labor that balanced the differing qualities of each parent.

The nature of the death

When a death is expected it is impossible to protect children from knowing what is happening. They see and they hear. Even in the case of a long illness, death is most often experienced as unexpected. While the shock of a sudden unexpected death is very profound, in the Child Bereavement Study families at the end of two years, this did not seem to be a factor in how children and their families accommodate to the loss (Silverman and Worden, 1993).

What does seem to be an issue for some children is how they understand what caused the death. This understanding can have repercussions on their own future physical and emotional well being. For example, several mothers died of cancer at the same age as their own mothers had died. For their daughters this knowledge created a fear and anxiety that needed to be named and legitimated. In one family where these fears were not recognized, the girls developed antisocial behavior that in many ways was self-destructive. It was as if they did not see much hope for their own futures. In contrast, in another family the genetic issue was addressed openly. The children were involved in learning self-care skills and in developing an attitude that would promote their involvement in the care of their own bodies. They understood there was no magic bullet but they didn't feel helpless and trapped.

In a family where the father died as a direct result of alcoholism, the mother had taught the children to see their father as a caring, loving man who had an illness. The children were able to see that there were two sides to their father. They could see the tragedy of his illness and how he fell victim to it, and they understood that nothing they could have done would have prevented this outcome unless their father changed. In contrast, in one family the mother was clinically depressed, but this was never explicitly acknowledged. The children had no idea that their mother had an illness or how this related to her death. They saw themselves as somehow to blame for her being upset and sad all the time, and this was reflected in the ongoing tension in the family.

The view children have of their parent's death and its repercussions for them depends on the surviving parent's ability to face the reality of what has happened, to give it words that accurately describe the condition, and to communicate this to their children to give them accurate information abut how the death affects them (Silverman, Baker, Boerner, and Chait, 1999).

The child's age and stage of development affects their sense of who died and what is lost. The typical research into children's understanding of death examines the child's responses to questions about the finality, universality, irreversibility, and causality of death (Koocher, 1976; Smilansky, 1987; Speece and Brent, 1996). When a parent dies, children grapple with the qualities of death almost immediately. However, their understanding is not simply related to age but to their experience (Bluebond-Langner, 1997). What children experience as lost with the death, how they talk about their parent, and how they understand his or her place in their lives may be more critical than the researchers' theoretical focus on children's age-specific understanding of death (Silverman, 2000).

Children's ability to know the other and to take the role of the other, to reflect on their own behavior and to see how they interact with others, increases over time as they grow and mature (Kegan, 1982, 1993; Selman, 1989). Younger children see their parent as someone who does things for them, who meets their needs. They need their parent to keep their world together and provide them with stability and certainty. They do not yet have the ability to experience their parent as a person with needs of her own. Each stage brings with it a different ability to understand and reflect on the world and oneself, and therefore to reflect on the meaning of the death. As the child matures they begin to set aside their own needs and become aware of the other person as someone with needs of her own, and by adolescence the child should be able to construct a relationship in which he can find a place for his own needs and the needs of others as well. With the death of his or her parent, children, depending on their age and stage of development, will have lost very different people (Silverman, 2000). For example, a child of seven says she is sad because "Daddy will not be there to throw me in the air when he comes home. We snuggled when we watched TV. Now I have no one to snuggle with."

At this age children have lost someone who did things for them, who gave them pleasure, who was there in the service of their needs. A child of ten will ask "Who will help me with my homework, who will play baseball with me?" As they get a bit older children are beginning to be more aware of their own needs, not only for someone to do things for them but with them. They can use words to state in a more abstract fashion what their parent provided them.

A child of twelve may say of her mother, "She was a good cook, I could talk to her about anything." At this age she has an awareness of individual parental qualities-but still as they meet her needs. By the time they are teenagers, when a parent dies, children talk about losing a friend. "We were really just getting to know each other." "The house is really empty without her voice and her laughter." There is a sense that what is lost is the developing interaction with the parent whom the child was just beginning to know. Older children can recognize what the deceased lost as well. As the child gets older his very sense of who died changes (Silverman, 2000).

Constructing a relationship with the deceased

Children seem to find comfort and solace from remembering and constructing a relationship with the deceased (Silverman and Nickman, 1996; Normand, Silverman, and Nickman, 1996). They do not live in the past but remain connected to the deceased in various ways that change as they develop. For example, a ten-year-old's construction reflects his understanding of what his father wanted for him: 'I always do my homework, he would be furious if I didn't do well in school."

His father still serves as an appropriate agent of control in his life. An older child can see his behavior differently: "it is important that I do well in school. It meant a lot to my father and it's like I am carrying on his memory in what I do."

The older child can take the role of his father and the part he (the child) plays in their relationship so that in a sense he becomes what we have called his father's "living legacy" (Normand, Silverman, and Nickman, 1996). Nickman, Silverman, and Normand (1997) observed the role of the surviving parent in helping their children find a place for the deceased in their lives. Parents' ability to help the child in part depends not only on how they view the mourning process, but on their understanding of where the child is developmentally.

The family system shifts and changes. The family drama centers on the ability of the system to deal with change. To a large extent how this takes place depends on the surviving parents' ability to orchestrate and guide the shifting scene at a time when their own resources are taxed beyond belief. The ability to do so depends on how they experience their own grief and how they understand their children's behavior. They will have difficulty if they do not see the connection between their children's age and stage of development, and the child's reaction to the death. Those parents who can involve the children in the family drama, who recognize their children as mourning and needing care and support, seem to have an easier time finding ways to shift gears and appreciate their own competence to act in the new situation (Silverman, 2000).

It is not easy for parents to recognize their children's needs as mourners. Many parents worry about whether or not the death of one parent will impair their children psychologically. While parents often focused on their concern that their children were not letting their feelings out, they were very relieved when children carried on as before, with few displays of disruptive or atypical behavior. There seemed to be at least two perspectives from which the parents responded (Silverman and Gross, 1996; Silverman, 2000). There were parents who were more child-centered and others more parent-centered. These patterns are not really mutually exclusive. Parents moved from one position to another with many gray areas.

Parent-centered families

These parents seemed to be centered on themselves and their concerns about how they would react given the pressure they now feel. They focus on the deficit in the family. Children in these families often talked about their parent's wish for them to behave and not to be disruptive. These parents often rationalized that the child's reactions were due to a developmental growth spurt rather than the death, ignoring that it was probably both. For example, one mother suggested that her six-year-old's nightmares were simply related to his age. In this way she minimized the impact of the death. Some parents could not separate their own reactions from those of their children, and it was difficult to know whose grief they were talking about. Most recognized their importance to their children, and they were indeed doing the best they could under the circumstances. From the point of view of physical care, all these children were well cared for. There was a sense of continuity in their lives, and they were going to school and continuing with their routine activities. There was not, however, a real sense of connection to how much the loss meant to them, and they did not feel legitimated as mourners.

Child-centered families

Parents with a child-centered perspective focused on how the family had to change to deal with the new situation. Child-centered parents were often proactive as they thought about their children's needs and could set aside their own needs for the moment. A mother of a six-year-old reported how worried her child was about whether or not the Easter bunny would come after her father's sudden death. The mother said that her older children wanted to be alone and needed time to be with their friends. This left the mother with space to focus on her six-year-old. Nonetheless, she was also aware that she was in no condition to deal with her young daughter's wish to make Easter eggs at the same time that she (mother) was arranging a funeral. She invited her niece to come and to color eggs in the mother's kitchen. She thus provided her child with the security of being in her own home and seeing that life goes on. This mother understood what was needed. She understood that focusing on the Easter eggs was what a six-year-old needed in order to feel secure in a world that had suddenly fallen apart in a way that she could barely understand. The mother was able to mobilize resources to help her meet her child's needs while respecting her own limitations.

Child-centered parents were aware that their children needed to learn to talk about the deceased as well as about the feelings they had never experienced before. One mother found a way to encourage her teenage sons to talk about their father and to help them validate some of what she thought they might be feeling. She invited them into a conversation, not about feelings but about their father. Talking about the deceased can often be more valuable than talking directly about feelings (Silverman and Nickman, 1996). Parents in this group were very clear that they would need to learn new ways to do the job of raising their children alone. Some were unsure how long it would take, but they knew that learning and change were involved. A father of an eight-year-old boy described the shift in his thinking from focusing on his own grief to recognizing his child's needs:

I worked overtime for six months after the death. I ignored what was going on at home, as long as things were quiet. I realized one day that I had a young son to raise and it was my responsibility not that of his older brother and sister. It was bad enough he lost his mother. He needed his father now.
Resources for Coping

Coping and adapting are dynamic processes as the bereaved family deals with the rhythm of their lives and the vicissitudes of their new and changing situation. None of us can deal with these changes without a little outside help. Thus, families found resources in others in their community, in themselves, and with each other (Silverman, 2000). The rituals and belief systems that frame their lives are also resources, as are clergy. Since children spend so much of their day in the classroom the role of the teacher is critical in helping bereaved children cope. In many communities there are additional resources that extend beyond the immediate helping network of the family. The mental health professional can be such a resource. Often when no specialized resources exist, as, for example, a center for bereaved children, parents themselves develop these resources. Often the role of the professional is to facilitate this process and collaborate with families to provide the range of services that may be needed in their community (Silverman, 2000). At times, to accomplish their goal may involve changing attitudes about death and grief in the community as well.

What do children need to help them adapt to their new situation? Children need to live in an environment that provides them with care, continuity, and connection (Silverman, 2000). Care is a synonym for social support. Children need to know that there is someone to be a guide for them, to teach them, and to provide feedback about how well or poorly they are doing, to "be there" for them-to meet their emotional, social, and physical needs. Children need to be listened to and to be recognized as active partners in the family drama. Is their voice heard? The spoken as well as the unspoken word? The nature of the surviving parent's response to the child's communication becomes very important. A child dealing with stress needs the safety of knowing that there is some continuity in their lives between the past, the present, and the future. Continuity provides the child with a sense that the family will carry on and find its way. Children need an explanation, regardless of their age, of how the family will manage. They need reassurance that family, friends, and others will be there for them, that while the family had a past it also has a future. Connection means both that the child is included as part of the family and the family drama and that there is a connection to the deceased and a place in the family for him or her. While the relationship has changed radically the deceased parent is still part of the family and part of the child's identity (Silverman and Nickman, 1996).

For parents to meet their children's needs is an enormous task. It comes at a time when the parents themselves are preoccupied and grieving and have little energy for the demands of single parenthood.

Children need:
  • to have their grief legitimized
  • to be able to learn in manageable segments so that they are not overwhelmed
  • to learn a vocabulary that can help them describe and live with the changes in their lives
  • to talk about who died, both positive and negative qualities
  • to develop ways of honoring the dead and recognizing that their parent can be both present and absent in their lives
  • to be included, in ways appropriate to their age and stage of development, in the family drama.
Parents need:
  • to recognize that they are dealing with change in their lives and in their very sense of self
  • to learn new skills appropriate to their new role as a single parent
  • to learn how to talk to their child(ren) about who died, the nature of the death, their common grief, and how they will build their new lives together.

There is no easy prescription to ease the pain but we can make learning easier when support and understanding are available to the family. There are ways of helping so that people feel less alone and become more competent to deal with the many faces of the bereavement process. The examples below for teachers and mental health professionals can help inform the work of other helpers as well.

How teachers can help:
  • Get as much information about what has happened as possible from the child's surviving parent, a close friend, or another relative.
  • Ask what the family would like from the school and what they think would be most helpful to the child.
  • Find out about funeral rituals and mourning practices and whether classmates can, with their parents' permission, be appropriately involved.
  • Talk with the class about what has happened and allow them to react; suggest ways for them to be helpful and provide comfort to their classmate.
  • In talking to bereaved children, listen to their story. Don't tell them how they feel or should feel, let them tell you how they, in fact, do feel. Some children don't want any special attention and some don't want to talk. Respect these differences.
  • Be aware of how children react in age-specific ways. Avoid stereotyping, generalizations, and giving unsolicited advice.
  • Recognize the long term repercussions for children and that from time to time they may be upset long past the time when you think they should be "over it."
  • Create a place in the school where children can retreat if they need quiet time for whatever reason.
  • Children may need space to grieve by withdrawing from the class either physically or emotionally, or by being actively involved in the class. Respect the fact that they may know what they need and when they need it.
  • Create a peer group with other teachers to talk about your own concerns about dealing with death in the classroom. Develop helpful guidelines and a curriculum that would facilitate this process.
How mental health professionals can help:
  • Do not assume you understand the needs of the bereaved or where they are in the process.
  • Encourage children and their surviving parent to tell their own stories. Let them be your guide and teacher.
  • Rather than looking for pathology and what is wrong, focus on helping people recognize the impact of the death on their lives and help them to find ways of changing and adapting.
  • Ask both children and their parent to tell you about who died before you ask about their feelings. What did they lose with this death?
  • Examine with the surviving parent what is involved for them in assuming the role of single parent.
  • Ask questions that help both the surviving parent and the children look at their belief systems and how they make meaning of what is happening to them, so that they can understand bow these affect their behavior and appreciate their ability to act on their own behalf
  • Learn to stay with the pain in the family, don't try to take it away.
  • Legitimize the need to remember and connect to the deceased.
  • Accept the paradox that the bereaved cannot live in the past but that the past is part of the present and the future.
  • Recognize that some problems have their roots in the family's pre-death experience and may need more traditional therapeutic interventions.

Helpers need to be able to look at the full picture, some of which has been described above. Their emphasis should not be primarily on how people feel and on the deficits in their lives. Rather, they need to help the bereaved hear their own story, assess their situation and help them develop appropriate resources as needed (Silverman, 2000).