1. Introduction
People are born, grow, live, and die. This cycle is a universal phenomenon. However, it is prevalent that people have difficulties with understanding the concept of death, reflecting on it, and accepting it. Death concept substantially varies across cultures, societies, and scientific disciplines, and these concepts can be subject to the influence of factors such as developmental preparedness, personality, and religion. These concepts share similarities when a living organism is unable to renew itself or its one or more vital functions [1].
The concept of death in psychology received particular attention after the Second World War although it can be traced back to early civilizations as a phenomenon. Psychoanalysts such as Otto Rank, Karen Horney and Erich Fromm are prominent amongst those who expressed their views on death, closely relating to existential psychology [2]. Psychoanalytic tradition maintains that human beings inherently possess two instincts: life and death. The life instinct refers to one’s desire to live. Death instinct stands for humans’ destructive tendencies. However, in contrast to the psychoanalytic instinct perspective, existential psychologists (e.g., Rollo May, James Bugental) suggest that human beings have the awareness of death, and that this instigates one to make sense of their life [3]. Thus, death is an integral part of life. As another approach on the death phenomenon, humanistic psychologists believe that people’s experiences are so intertwined with their lives that they fear losing what they have (e.g., body, self, properties). So, one is afraid of losing what they possess in life [4].
These perspectives have evolved and been revised over time given that theoretical and research priorities have changed. However, the effects of these perspectives on one’s life remain debatable [5]. The way people consider death can affect their biological and psychological reactions. Although these perspectives illuminate the distinct aspects of the phenomenon, they lack a developmental perspective to explain it. More importantly, it is particularly relevant when explaining the phenomenon and its effects in our lives to children. Children developmentally go through a number of stages. It may be quite difficult to address this task given that children are less qualified to abstractly reason compared to adults. Accordingly, the developmental preparedness of children requires further clarifications regarding understanding the death phenomenon among children.
One fundamental concept here is “grievance.” When people lose one of their loved ones, they experience intense and overwhelming emotions (e.g., anxiety, grief, sadness) in the grief process. When people grieve for their loved ones, they may have difficulties with emotional and spiritual functioning in their daily lives [6]. Grief is a process in which people are supposed to learn how to accept the death phenomenon and their reactions to it, to cope, and to move on despite the presence of the reactions. It can be quite difficult to experience grief even though it is prevalent and acceptable [6]. People need time, support, and courage to address this process. This process is particularly hard among children as they may be unable to understand the death phenomenon [7]. Since the concept of death is an abstract concept, children may not know how to express their emotions. When they do not know how to experience those feelings and process them, they may not effectively go through the grieving process. In this article, we propose that the contextual conditions of children’s developmental processes are the building blocks of understanding the death phenomenon among children. Thus, this article examines the role of developmental processes, particularly cognitive abilities, in understanding the death phenomenon, and children’s grief reactions.
2. Death Concept in Development
Children are aware of the death phenomenon. They hear or face one’s death in their environments. They are exposed to an immeasurable amount of information on death through social media and video games. Children somewhat know the phenomenon as it is prevalent. When one talks to children about death, they should be careful about what they say, and effectively express themselves, especially when explaining death. So, as Bonanno et al. suggested, they must be informed about children’s age and past life experiences [8]. Although individual differences reflect different experiences, beliefs, emotions etc. [9] This article conceptualizes the developmental processes based on cognitive abilities as reflected in the following parts.
0 - 2 years
Bowlby (1980) suggests that the development of death concept in children begins when children are seventeen months old. It has previously maintained that death is a high-level abstract concept that toddlers are unable to understand. However, they can remember their feelings and keep the lost object in memory. When children are separated from their caregivers or lose them, it is not uncommon to observe sadness, protest, and helplessness reactions [10]. To illustrate, six-month old babies may show an aggressive attitude when their mother passed away. Still, babies cannot distinguish between the long-term absence of the mother or her death [9].
2 - 5 years
The distinction between death and life is completely unclear in these ages. Children consider someone dead “less alive” in comparison to the living [11]. Children can connect sleep and death, and think death as a deeper sort of sleep. From their perspective, death is reversible, temporary, and personal. They may believe that someone deceased lives in another place and life, and they will come back [12]. For this reason, children often ask where the dead is gone and when they would return. Children cannot fully grasp the real meaning of the idea that everyone will die someday [9]. Also, children may blame themselves for the complexity of death because they are egocentric [13]. They may think the lost person died because of them, and if they had been better children, they might have saved him from the death. In these ages, children can easily express their feelings, thoughts, and concerns. However, then their language development is not sufficient enough, they may face some adaptation and behavioral problems (e.g., sleep, aggression, withdrawal, eating disorders) [9].
5 - 9 years
Children begin to synthesize the concept of time and they are better positioned to understand the finity of human lives. So, children understand when someone dies they will not come back. However, they still find it difficult to understand the inevitability of death for everyone. As Meadow [13] expressed, people die only because of events (e.g., illness, traffic accidents). They think it is still possible to escape from death even though death is an end [11]. When children have very strong connections with people they lost, they may be inclined to identify with them. It is thought that this is a normal reaction and will disappear over time [9]. Yet whether this situation can be pathological should be considered. Children may fear of death since they tend to express themselves by symbols (e.g., angels, skeletons). They may believe those angels or skeletons can come and disturb them. Some words (e.g., spirit, corpse, ghost) can horrify them. Still, they are curious about the death and interested in exploring more about it.
9+ years
Children begin to understand that death is irreversible and experience by all livings [11]. They comprehend that death is a universal phenomenon and life ends when death is there. They do not believe someone dead will come back again. They are aware of the fact that their loved ones (e.g., parents, friends) and themselves will face the death someday. And they may develop anxiety. However, they may still not be able to have a clear judgment on the causes of death. They may believe something caused the death, and that our deeds, good or bad, may affect our death. They may have changes in their lives to avoid the death fear.
3. Grief and Developmental Processes
The loss of a loved one in childhood, especially the loss of a parent, is a difficult and overwhelming experience. It is widely accepted that children go through a harder grief process than adults [14]. In this process, there are two main issues to be addressed. First, one’s death is irreversible, but children are not mature enough to develop this abstraction. This is particularly challenging as children rely on significant others for care. Second, children’s early experiences of attachment and trust are closely connected to their caregivers, especially parents [14]. Every child has different reactions in the grief process based on their cognitive readiness and abilities. It is possible to distinguish between expected and complex grief reactions. When these reactions exceed the expected range of grief reactions, they can be pathological and dysfunctional. One of the most important distinctions to consider those reactions pathological is whether one’s functionality in their personal, social, and/or professional deterioration after six months passing [15]. This is especially important among children. Therefore, grief in developmental processes can provide valuable insights into children’s experiences. We provide expected and complex grief reactions as follows.
0 - 3 years
Babies are not able to understand the death phenomenon, while they can recognize and react to their caregivers, their presence or absence. These are valuable hints in the grieving process.
Expected grief reactions:
When children lose their caregiver(s), they will look for the caregiver and cry when the caregiver is not available to them. They may reject a new caregiver. The following reactions can be expected:
Observing emotional inability with lethargy, unwillingness to participate in activities on their own, the loss of appetite, and sleeping problems.
Complex grief reactions:
Babies may have restricted affect and show hypersensitivity to anything that reminds them of the caregiver [16]. They may show reactions such as separation anxiety, lack of interest, and the gradual deterioration of acquired developmental characteristics.
3 - 6 years
Children perceive death as a temporary and reversible phenomenon. They may associate death with magical thoughts or metaphors. To exemplify, they may think one has gone to the sky or become a star. These can affect the way they experience the grief process.
Expected grief reactions:
They may experience strong mood swings and have difficulties with handling them. They constantly stive to find the dead. They are affected by changes in their life routines and the way their relatives experience the grief process. They may temporarily show regression behaviors such as baby talk, thumb sucking, wanting to sleep with a sibling or parent, and problems in eating and sleeping [14].
Complex grief reactions:
As children cannot control their emotions, they may cry and experience fits of rage that are constant, destructive, and harmful. They may regress to behaviors such as enuresis, clinging on their caregiver(s), and troublesome behaviors among their peers [12].
6 - 9 years
Children gradually begin to understand the concept of death in its true sense at this stage. The idea that the deceased will return fades, and they come to accept that death is the end of life. Consequently, their reactions during the grieving process are shaped by this acceptance.
Expected grief reactions:
Children may attempt to commemorate death with magical thoughts. Death can be associated with concepts such as a spirit, ghost, or angel [14]. This may cause them to fear such symbols and concepts. If they closely identify with the deceased, they might imitate their behavior and take on their role [15]. In addition, they may perceive death as a punishment and blame themselves for it.
Complex grief reactions:
Children may have difficulty concentrating at school. This situation may lead to school refusal due to the fear and anxiety brought by the grieving process. Children may exhibit physical symptoms, and have suicidal thoughts or display regressive behaviors [17].
+9 years
Children at this cognitive level are aware of death and perceive it as an irreversible end. They can comprehend the long-term changes that one’s death will bring to their lives. Thus, grief reactions are closely associated with this cognitive understanding.
Expected grief reactions:
A period of intense questioning begins about how and why death happened. They ask questions about the nature of death [12]. Their emotional reactions manifest as anxiety, shame, guilt, sadness, and anger. Gender may affect the way these reactions are experiences. Boys typically show their emotions through aggression and destructive behaviors, whereas girls are inclined to show increased attachment behaviors [14]. They may also feel guilt, resentment, or responsibility for the death.
Complex grief reactions:
As they can understand the concept of death more realistically, they may experience an intense fear of abandonment, and worry that they or others will die. Emotional states in these children may fluctuate intensely, typically resulting in a constant anger cycle.
Behaviors such as decline in school success, school refusal, truancy, and dropout can be observed. They may suffer from persistent depression and social withdrawal or isolation. Critical issues are the initiation of substance use and deterioration in sexual behavior [14].
4. Supporting Children in Times of Grief
Studies with children demonstrate that children should properly be informed about death for healthy development [6]. Helping children when they experience a loss requires understanding their reactions in a developmental context [18]. Key points are as follows [19].
1) Open and honest communication: Appropriately explain death to children based on their age and developmental level. Make sure that they understand that birth and life have an end.
2) Avoid abstract explanations: In order to prevent any potential confusion, refrain yourself from making abstract explanations and do not explain death as a journey.
3) Gradual disclosure: Explain events (e.g., death) gradually rather than suddenly.
4) Encourage questions: Let children ask you questions while you speak. Be patient when children repeat their questions and make sure that your answers are consistent.
5) Reassure safety: Tell children that the surviving family members are safe to reduce the level of anxiety.
6) Support emotional expression: Share children’s feelings and support them to express their emotions.
7) Keep routine: Children’s environments, relationships, and daily activities should remain as unchanged as possible. Life should continue as normally as possible.
8) Look for professional support: In case grief reactions become too excessive, seek professional support.
5. Conclusion
Death is a universal phenomenon that cannot be avoided. Despite this, all individuals struggle to understand and accept it. For children, this is more challenging as their perception of death can be affected by several factors (e.g., understanding abstract concepts). Key factors encompass age, gender, attachment, cognitive development, emotional expression, living environment, individual experiences, and cultural norms. However, the most crucial factors are their mental and emotional development processes. Therefore, children’s perceptions of death and their grief processes should be examined and analyzed in a cognitive development context. This article clarifies this context in order to provide accurate guidance and support to help children navigate the grieving process healthily.