Is Death Anxiety More Prevalent in Children than in Adults - Coursework Example

Critically evaluate the notion that death anxiety is more prevalent in children than in adults. Introduction Death is inevitable. As adults, we view death as a reality. However, children have a limited schema and behavioural repertoire for understanding the meaning of death. A Hungarian psychologist, Maria Nagy, was able to establish a relationship between a child’s chronological age and the understanding of death. The ages are estimates due to individual differences. According to Nagy (1948), the comprehension of death among children can be divided in three stages. In stage 1, children aged three to five see death as a faded continuation of life. They view dead people, or animated objects such as pets, as asleep and who might not wake up for a while. In stage 2, children aged five to nine see death as final. The dead stay dead, but often they picture the dead person as taking in another form like a ghost or skeleton or live in a coffin or in another world. However, they also believe that death happens to the sick or the aged, and that there is a possibility of escaping death if one follows a healthy lifestyle or is fortunate to have a long life. At the third and final stage among children aged nine and thereafter, children have a more mature take of death and view it as inevitable, universal, and personal, and that all living things die, whether a mouse, an elephant, a parent or a stranger, and no matter how good or how clever people are, they still die (Kastenbaum, 2010). It is with this concept of the finality of death that people become anxious. Sigmund Freud coined the term “thanatophobia”, meaning the fear of death or death anxiety. He postulated that people express their fear of dying, not because of death itself, but because of an unresolved childhood issue that they cannot bring to acknowledge and discuss openly. According to Freud, nobody has experienced death, what it is to die, and in the unconscious mind, everyone is convinced of their own immortality (Kiff, 2009). Becker (1973) in his book, The Denial of Death, viewed death anxiety as a feeling that is so intense that it generates what people fear or what their phobias are in everyday life. For example, being in an enclosed space or high up in a building are fears whose connections with death anxiety are easy to trace. However, for most people, anxiety towards death is kept to a minimum by denying death. This is also where society plays its role by creating beliefs and practices that can subdue the fear of death. Funeral homes with their flowers and homilies; the medical system with its evasions; and religions reiterating the concepts of the afterlife are among the more obvious societal elements that help individuals to maintain the fiction that there is nothing to fear (Kastenbaum, 2010). As mentioned above, for children below the ages of nine, dead people are in a temporary state of being; being asleep but will awake soon; or as far as many children are being told by adults about where their pets go, they were sent to a farm. Having no thoughts of death gives them a sense of immortality and a devil-may-care risky behaviour which some exhibit until their adolescent years. On the other hand, children of any age who have experienced death in the family view death more maturely. However, do they react the same way as adults do? Do they cover up their anxiety about their own death in mature ways, or do they behave in ways that are not typical of adults who have lost a loved one? The purpose of this paper is to evaluate whether death anxiety is more prevalent in children than in adults in the areas of chronic pain and experience of loss. Review of Literature Children are the miniature version of adults. Even in medical practice, with the exception of infants, they are treated the same way as adults. This occurred until researchers found that although children manifest the same kind of disease as adults, they have different symptoms. For instance, when adults have acute appendicitis, often the abdominal pain is localized on the right side. In children, however, the abdominal pain may be felt in any part of the abdomen and accompanied with loose bowel movement, which doctors may diagnose as diarrhea and not acute appendicitis (Jaffe & Berger, 2005, p. 1122). Moreover, children react differently to certain medications. This distinction between children and adults is also true in the psychology of death and dying. Losing one or both parents is one of the most adverse events in a child’s life and can substantially impact their functioning and development. In western countries, an estimated 1.5-4% of children lose at least one parent during childhood (Hasky, 1993). This percentage is higher in developing countries and those affected by natural disasters, war and civil conflict (Black, 2002). Despite the frequency of children exposed to natural disasters, studies conducted on the effect of trauma were focused on adult war victims (Kendall-Tackett et. al., 1993; McNally, 1991). It was assumed that children’s reactions to trauma would be same as adults’ (Anthony et. al., 1999). However, a study conducted by Terr (1979) showed that children acted differently and did not “bounce back” like most adults. More often, they showed long-term problems and generalized their fears. An earlier study conducted by Rutter (1966) showed that bereaved children are at risk of developing mental health disorders. Bowlby (1980) proposed that early loss in the children’s lives predisposes them to early depression (as cited in Kalantari & Vostanis, 2010). Wolff (1987), moreover, established that parental loss can be a predictor of parenting difficulties in the child’s later life. Likewise, only a few studies have been written on the child’s traumatic grief reactions (Rynearson et al., 2002). Another difficulty in assessing children’s reactions to death is that they are not given permission to mourn. According to Wolfet (1998) and (Reily, 2003), to mourn is to share one’s grief with others. Yet most adults do not talk about death with children, because well-intentioned adults believe that this discussion is “too much” for the children (Kubler-Ross, 1969) and might cause stress and anxiety. Adults also fear their own emotions and how these will affect the children (Black, 1996; Schaefer, 1988); thus, their own anxieties prevent them from discussing death-related issues with their children (Blank & Sori, 2006). In a review done by Kalantari and Vostanis (2010), emotional and behavioural problems of children at the pre-school level stemmed from the mental state of the surviving parent or other caregivers. Such different behaviours may manifest from being submissive to rejecting, adaptive to maladaptive, and accepting to denying. These different interpretations to the event vary according to cultural context, which involves the attitudes, beliefs, rituals and practices within the family, school and community. Discussion To understand the prevalence of death anxiety in children, one must first comprehend a child’s understanding of death. According to Gudas (1993), the degree of a child’s capacity to understand the concept of death is directly related to their developmental stage. In the infancy period, aged from 1 to 2, children learn through their senses. Little is known if infants know the difference between life and death, but it is commonly accepted that infants and toddlers have little or no real cognitive understanding of death. Death is equated to separation; hence, death is expressed through separation anxiety (Stillion & Papadatou, 2002). Children at the preoperational stage of cognitive development, at around three to six years of age, believe that they are at the centre of attention. Children at this stage believe that death comes from the outside, and that wishing and magic can make the dead alive again (Sourkes, 2000). These children are not anxious about death, because they believe that one can escape death. As children enter the period of concrete operations, at around 6 to 10 years, they are mastering their environment by developing more complex associations and logical reasoning (Maier, 1978). During this stage, children acquire all aspects of a mature concept of death. One major study (Waechter, 1987) revealed that children with a serious illness with poor prognosis have increased levels of anxiety compared with other children who also suffered from a chronic illness but had a good prognosis. Anxiety among the seriously ill children was related to fears concerning death, mutilation imagery, and a sense of loneliness. A study conducted by Slaughter and Griffiths (2007) on 90 preschool and primary school children between the ages of 4 to 8 years in Brisbane, Australia, showed the same results as previous ones. They conducted a personal interview with the children and also asked them to answer a questionnaire that was interpreted with a death anxiety scale for children. It was found that the children’s understanding of death and expression of fear is correlated with age. However, it was able to conclude that there is no gender difference in the anxiety levels of children as compared to adults. Another study conducted by Spinetta et al. (1987) reinforced Waechter’s findings by discovering that even when children are not told of the seriousness or the fatality of their disease, they are aware of its seriousness and experience increased levels of anxiety which they express in subtle and indirect ways. Some research has captured the complexity of developing an understanding of death through the analysis of specific subcomponents that contribute to a more mature concept of death (Landsown & Benjamin, 1985; Speece & Brent, 1996). The five major aspects of death understanding which are mastered by children aged five to ten are: (1) inevitability; (2) universality or applicability; (3) irreversibility or finality of death; (4) cessation or nonfunctionality; and (5) causation. Developmental researchers investigating the progression of subcomponent acquisition have generally found that irreversibility or the acknowledgment that the dead stay dead and cannot come back to life first occurs by the age of 5 or 6. Next comes universality (death happens to all living things), inevitability (all living things eventually dies) and cessation of functionality of bodily processes. Causality or the understanding that death is ultimately caused by the breakdown of bodily function is more complex and comes last and by age 7 to 10, at which time all the subcomponents are acquired. Around age 12, the stage of formal operations, children move from mastering their environment to philosophising certain events in their lives, including the concept of death. They can visualize the future better than younger children; however, they often return to the preoperational stage of egocentrism and believe that death can happen to others and not to themselves (Elkind, 1967). Caregivers of seriously-ill children at this stage may find some difficulty when their patients accept this notion and do not adhere to medical regimens, especially when their treatments have distressing side effects. For some children, social expectations compel them to act more like an adult by concealing their grief, to cry only in private (Reily, 2003). For children, death elicits shock, denial, great anxiety and distress. Their independence has been disturbed and the loss of a parent rekindles feelings of hopelessness, dependence, and fear (Reily, 2003). In order to control these feelings, children put on a façade of independence and coping, which only heightens their anxiety and distress. They deny death and fantasise the continued relationship with the dead. They attempt to act in a grown-up manner to cover up their pain and fears. Their actions are often manifested as phobic behaviours and they sometimes feel they have contracted physical illnesses; however, upon examination of a doctor, they are found to be physically normal (Rando, 1984; Worden, 1996). In expressing their emotions, anger is the easiest to express. Anger masks fears, insecurities and helplessness. However, anger also intensifies fears and anxiety by making people prone to lash out aggressively. These kinds of behaviour are interpreted by adults as exhibiting unacceptable and irresponsible behaviour, thus children exhibiting these behaviour are punished or given no support for the mourning process and in some children, develop depression. Going through the stages of understanding death could affect a child’s fear of death in either a positive or negative way. The negative predilection is that when children reach the mature concept of death as being inevitable, universal and irreversible, it might instil the fear that every living thing around them will eventually die, and eventually they themselves will die (Kastenbaum, 2010). The greatest fear is that they can die too young and not be able to experience all that life has to offer. On the positive side, when children have a mature concept of death, this reduces anxiety because they understand the natural process of the lifecycle and will no longer deal with unanswerable questions arising from their previous perceptions. These include why the dead person has not awakened yet; why a relative chose to live in a box; or why their pet has not yet come back from the farm. Conclusion Many studies demonstrate that children experience death anxiety and numerous methods have been used to measure anxiety levels in children. However, limited studies are available that compare the prevalence of death anxiety between children and adults. Studies have only established that death anxiety is present in children at any age and this expressed in different ways than in adults, depending on their developmental level. Most studies had similar findings, asserting that children understand death in the context of their developmental stage. 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