Article Type : Research Article
Authors : Maria Grazia Spurio
Keywords : Covid-19; Bereavement; Children; Narration
The measures taken to
limit social contacts in the period of the lockdown due to the Coronavirus-19
pandemic, led to a series of changes in the ways of social interaction which
have determined (and will determine in the future), an emotional and psychological
impact for everyone, in particular for children. They found themselves suddenly
immersed in a reality outside normal frame of reference and routine, outside
those “containers”, first of all the school, but also the group of friends,
which guarantee certainty and predictability. In the most serious cases, the
children also had to deal with the loss of a person with whom they had shared
games and moments of life and who, perhaps, represented a figure reference,
such as parents or grandparents.
The situation is made
even more complicated by the fact that, at the moment of death, it was not
possible to carry out all series of rites of passage, such as the funeral and
the related traditions, which are important because they represent a sort of
final greeting for the their culture.
The modality of
expression chosen to face psychological trauma needs a specific language which
fits for the child: for example Düss’s fables, the test of fairy tales, art
therapy, dramatization and drawing. Whatever method is chosen, it must adapt to
a series of new psychological problems that we, as professionals in the
psychological and psychotherapeutic sector, are today having to deal with, as
well as in the immediate future.
Analysis
of a bereavement at the time of the coronavirus: through the eyes of a child
The
emotional impact of the immediate cessation of traditional social interactions,
the inability to say the final farewell to deceased
loved ones, has been enormous for adults, and we
can imagine the consequences more for the children. Even for children, in fact,
the presence and participation in the mourning rituals is functional
experience, because it allows them to feel an active part in giving farewell to
the lost person. It would therefore be necessary, in all cases, but in
particular when the capacity of the child transcend the
possibility of facing traumatic events, going towards
requesting for a specialistic
help, whose success depends on a multiplicity of factors,
such as the circumstances of death, the quality of the relationship that linked
the child to the deceased person, the resources of those who remains close to
the minor to cope with adverse events, the possibilities offered by the
reference context, his personal resources, the presence of other bereavement,
the quality of social relationships, the presence or absence of
psychopathologies.
The
importance of not underestimating the consequences of the situation of
bereavement or loss resulting from Covid-19 is particularly relevant also in
consideration of the fact that the onset of this disorder can also occur for
some time after the emergency has ended. Psychological trauma derives from
being exposed to an event that is perceived as potentially dangerous for one's
life or that of others, or potentially capable of generating serious physical injury
to oneself or to others. The limbic system intervenes in the processing of
behaviors related to emotions such as fear or intense psychological pain and it is
involved in the memorization processes. The amygdala plays a central role in
this system related to the perception of fear and the processing of the
resulting reactions. The amygdala is considered a sort of entrance door for
the emotions that are registered here, triggering the adaptive physiological
reactions. The consequences of the alterations
of the cerebral circuits involved in the emotions connected to the mourning
process have proved to be more serious, the earlier the age
of the traumatized subject [1].
It
is essential, with the help of a therapist, to implement some simple behaviors
to accompany a child in his personal elaboration. From a practical point of
view, it is important, in the days immediately following the bereavement, to
find small rituals that can be performed at home,
even better outdoors, with family members, perhaps repeated
even for a few days, which can also allow the little ones to feel an active
part of the farewell and to express pain and suffering for the loss suffered.
Elaboration of
bereavement for a child: the importance of narration
As for the methods of elaboration
through the narration, we can support the process by allowing the children to express on the delicate themes of
grief and pain with their specific languages, which are different from those of
adults, in order to validate their emotions. The important thing is that they
express themselves in some way, not letting them face the suffering in silence, because this could lead to psychosomatic reactions, such as intestinal
disorders, excessive agitation, insomnia or migraines, just to name a few
[2,3].
Psychological investigation tools, such as the fables of Düss for example, where small fables or
stories in which a protagonist finds himself in a specific situation that
refers to one of the different stages of psychosexual development (oral, anal,
oedipal, etc.). The method of the stories to be completed turns out to be a
means of rapid investigation, replacing the child's direct psychoanalytic
investigation. The tales conceived by Düss can be a means of quickly
identifying any discomfort or suffering that overwhelms the child's ability to
overcome them without therapeutic help, and their degree of severity which can serve as a starting point for psychotherapeutic
intervention on the child. This useful tool is intended for
children up to 11 years of age.
In the case of a therapeutic aid
oriented to the elaboration of grief, one can choose from the ten stories. For example, the fourth is useful for
investigating aggression, the desire for death, guilt, self-punishment. This
fable could be used starting precisely on the difference between the period of
the pandemic just experienced where the funeral did not take place and the
theme of the story which is, in fact, 'the funeral'. The fifth is instead 'a
story of fear', which provides valuable insights for investigating anguish and
self-punishment; the ninth is 'the story of the news', useful for exploring the
theme of the child's wishes or fears. Finally, the tenth, 'the bad dream' necessary for checking the previous
fables [4].
Another test that
optimizes the symbolic value of the stories is the fairy tale test (FTT - Fairy
Tale Test) which uses as a stimulus a series of illustrated tables of the main
characters of some widely known and widespread fairy tales, such as Snow White
and the Seven Dwarfs, Little Red Riding Hood, Hansel and Gretel, Tom
Thumb, Jack and the Beanstalk. Due to their symbolic content and structure, the
tables are well suited to express central aspects of children's experience,
fears, and anxieties [5].
The use of art therapy
and dramatization is also particularly useful, also in consideration
of the fact, which
is already illustrated, the expression of emotions in children must take place
using their personal way of expressing themselves and communicating [6]. This
is a method of taking care of
a person, especially a minor, with the expressive methods of artistic language,
images or representations or stories. In the case of child drawing as a
therapeutic means, a tool is available that can help to “read” behind the facade
and then place oneself in the most suitable way to be a healthy overcoming
of trauma and grief, and favor the consequent psychological development [7].
It is important to
help children understand that they are not the only ones to have experienced
the traumatic situation, as there are
other children who, like them, may have lost a grandfather or another important
person. This helps them feel less alone. It is also necessary to create
situations where they can give vent to emotions through physical activity using
outdoor spaces, to avoid the risks of a drop in their mood and sleeping disorders. It is also
necessary to speak of death in a language accessible to them, as we have seen
when talking about stories or fairy tales.
The advantages of being out in the open air and the benefits of contact with nature can
be combined and optimized with those of intervention and therapeutic
investigation. For example, a child can be asked to draw a tree; having this a psychological impact of different importance if the
execution takes place in a room or in an open environment in the presence of
trees. In the book by Bandinelli and Manes, "The drawing of the child in
difficulty” [8], the “tree test”, the way in which the child draws
the tree as a man, the crown, the stem, the branches, is an indicator of the difficulties that one experiences the
moment of
bereavement and loss, it is a useful tool for investigation and
intervention through the free expression of one’s emotions and management in overcoming the trauma.
We are facing an
important turning point both from a social and psychological
point of view, because
if on one hand it is true that the moment of the lockdown resulted in the necessity to suddenly face
unexpected challenges for which we were not prepared, professionals in the sector must
now offer specialized help to process the trauma suffered, on the other hand we are facing a “new normality”.
Everything has changed. The
anxiety of the contagion has not ceased, it has been necessary to rewrite new
ways of socializing, of learning, of working. And if these changes have had a
huge impact on adults, we can only imagine what the consequences will be for
children, who are in the existential stage in which the appropriate tools to
cope with difficulties are developed. It is during the first years of life that
children learn how to
effectively deal with the first obstacles and problems, and at the same time they start to develop
resilience, that is, the ability to react autonomously and effectively to
trauma and difficulties. Resilience is therefore the ability to deal positively
with traumatic events, to positively reorganize one's life in the face of
difficulties, to rebuild oneself while remaining sensitive to the positive
opportunities that life offers, without alienating one's identity [9]. This
process of mobility and elasticity takes shape in the early stages of life and
will be decisive and fundamental for the rest of an individual's existence,
determining the personal way of dealing with difficulties and change throughout
ones entire life
[10,11].
If in the early
stages of life, the trauma exceeds a child's ability to deal with it
successfully, it will become a severe risk factor not only immediately, but also later. If the ability to
self-repair lack, there is an
important probability that the adolescent will tend to develop
psychopathologies and maladaptive behaviors, first becoming a teenager at risk,
then, as an adult, by manifesting psychopathological
consequences such as conduct disorders, affective and deviant behaviors, due to the inability to
adapt and successfully face life's challenges [3].
Now, therefore, the strength to successfully deal with trauma is sought
by resorting to small everyday rituals, in family habits, which reconstruct
lost certainties. This is because, a functional processing of the trauma must
make use at this time tools capable of adapting to the 'new normality'.
Whatever new normality emerges in the months and years to come, psychologists and
psychotherapists of all stripes - school, community, research and more - should
be part of the solution. The whole world is adapting right now, and
professionals in the sector must know how to “take psychological science
and apply it”, encouraging each other to step up and learn to improve our
society.