How Children Make Meaning of Illness and Suffering and Why It Matters

Paul Thayer

Wheelock College

Session Outline

• Introduction• How children understand illness and death,

and why it matters• How children understand ethics and why it

matters• How children understand suffering and why it

matters• Closing comments

How are we sometimes limited in our understanding of coping and

spirituality?

Children and Coping

• Emotional-based coping• Play-based coping• Information-based coping• Decision-based coping• Meaning-based coping

Information-Based Coping

Understanding IllnessBibace and Walsh (1980)

Understanding DeathThanatos (1995)

Understanding Illness and Death: Infants

• No real understanding• Encounter issues of separation, pain,

environmental stimulation, safety, caregiver transitions

What Helps: Infants

• Parental presence in induction and recovery• Security objects• Adequate pain management• Attention to lights and people in the room• Routines• Treatment rooms for procedures• Attention to lunch time and shift changes

Understanding Illness and Death: Pre-Schoolers

• Phenomenism• Contagion• Death is temporary and reversible• Death mixed up with sleep

What Helps: Pre-Schoolers

• Everything for infants• Brief explanations before procedures• Choices• Correct magical thinking

Understanding Illness and Death: School Age

• Contamination and internalization• Beginning to master the concepts of non-

functionality, irreversibility, and universality

What Helps: School Age

• Everything for pre-schoolers• Control• Explanations of the illness process• Ask about guilt and punishment

Understanding Illness and Death: Teens

• Physiologic processes• Psychophysiological processes• Adult understanding of death

What Helps: Teens

• Everything for school age• Peer contact• Participation in decision making

Why Information-based Coping Matters

• Misinformation or misinterpretation leads to fear

• Information needs to be matched to developmental stages and capacities

• Maslow’s Hierarchy: If issues of safety, security, pain management, and basic questions about what is happening are not addressed, it is difficult to move on to anything else

Why Information-Based Coping Matters

• Kids often “know” more than they understand• Our explanations need to grow up with them• The luxury of time

Decision-Based Coping: Ethics

What is Ethics to a Kid?

• Immediate concerns• “Small” concerns• Egocentric

Why It Matters How We Understand Ethics

• Responding to tone rather than content• Failing to hear the ethical message• Shutting down conversation by being

prematurely comforting

Meaning-Based Coping: Interpretation, Significance, and Narrative

What is suffering?

• Suffering is a threat to the integrity of a person as a complex psychological and social being; suffering is experienced by persons, not just their bodies

– Cassell 1982

Meaning Making and Spirituality

• Suffering is a challenge to meaning that calls for a meaning-making response

• Suffering is an intrapersonal spiritual issue that calls for an interpersonal spiritual response

What is Suffering to a Kid?

• Loss of wholeness• Loss of a significant person• Loss of identity• Loss of friends• Loss of routines

Kids and Meaning Construction

• Meaning making by proxy• Meaning construction• Meaning reconstruction– Assimilation– Accommodation

Some Meaning Reconstruction Questions

• What have you been taught?• Do you believe it?• Does it make sense to you?• What do you believe?• What do you believe differently now that this

has happened to you?• What do you wonder about?

Concluding Remarks

• Many kids who are not in spiritual distress also need our help and presence

• We are often too invested in being cheerleaders or closure fairies

• We often miss chances to help because we focus only on emotional coping

Concluding Remarks

• Spirituality doesn’t just happen, it is co-constructed:– Feelings– Imagination– Questions– Decisions– Interpretation

Concluding Remarks

• Being in the Zone of Proximal Spiritual development