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Pediatric Terrorism and Disaster Preparedness

Public Health Emergency Preparedness

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Table 8.1. Concepts of Death and Implications of Incomplete Understanding for Adjustment to Loss

Concept Example of Incomplete Understanding Implication
Irreversibility
Death is seen as a permanent phenomenon from which there is no recovery or return. Child expects the deceased to return, as if from a trip. Failure to comprehend this concept prevents child from taking the first step in the mourning process, that of appreciating the permanence of the loss and the need to adjust ties to the deceased.
Finality (Nonfunctionality)
Death is seen as a state in which all life functions cease completely. Child worries about a buried relative being in pain or trying to dig himself or herself out of the grave; child wishes to bury food with the deceased. Can lead to preoccupation with physical suffering of the deceased and may impair readjustment; serves as the basis for many horror stories and films directed at children and youth (e.g., zombies, vampires, and other "living dead").
Inevitability (Universality)
Death is seen as a natural phenomenon that no living being can escape indefinitely. Child views significant individuals (i.e., self, parents) as immortal. If child does not view death as inevitable, he or she is likely to view death as a punishment (either for actions or thoughts of the child or the deceased), leading to excessive guilt and shame.
Causality
A realistic understanding of the causes of death is developed. Child who relies on magical thinking is apt to assume responsibility for death of a loved one by assuming bad thoughts or unrelated actions were causative. Tends to lead to excessive guilt that is difficult for child to resolve.

Source: Adapted from Schonfeld D. Crisis intervention for bereavement support: a model of intervention in the children's school. Clin Pediatr 1989;28(1):27-33. Reprinted with permission of Sage Publications, Inc.

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