Dealing with Dying, Death, and Grief during Adolescence

David E. Balk

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781136286490
• Edition: 1
• Topic: Psicologia
• Subtopic: Psicologia dello sviluppo

For some, life's introduction to death and grief comes early, and when it does it can take many forms. Not only does Dealing with Dying, Death, and Grief during Adolescence tackle them all, it does so with David Balk's remarkable sensitivity to and deep knowledge of the pressures and opportunities adolescents face in their transition from childhood to adulthood. In seamless, jargon-free language, Balk brings readers up to date with what we know about adolescent development, because over time such changes form the backstory we need to comprehend the impact of death and bereavement in an adolescent's life. The book's later chapters break down the recent findings in the study of life-threatening illness and bereavement during adolescence. And, crucially, these chapters also examine interventions that assist adolescents coping with these difficulties. Clinicians will come away from this book with both a grounded understanding of adolescent development and the adolescent experience of death, and they'll also gain specific tools for helping adolescents cope with death and grief on their own terms. For any clinician committed to supporting adolescents facing some of life's most difficult experiences, this integrated, up-to-date, and deeply insightful text is simply the book to have.

David E. Balk is professor in the department of health and nutrition sciences at Brooklyn College (CUNY), where he directs the graduate program in thanatology. He is the author of Adolescent Development: Early Through Late Adolescence, Helping the Bereaved College Student, and several other books on death and bereavement. He is also co-editor of the 2 nd edition of the Handbook of Thanatology (Routledge, 2013).

1
Adolescent Development and Serious Life Crises¹

Adolescence is a perplexing time, mainly to adults but also at times to adolescents themselves. Adults for the most part (particularly parents) realize the dynamism and energy of adolescents, yet see them at times lethargic and bored and at other times restless and agitated. Adolescents can find their lives perplexing given the many changes occurring to them and the multiple demands on their attention. The many changes include physical, cognitive, interpersonal, and self-awareness issues; the multiple demands on their attention include family matters, peer expectations, school work, electronic media bombardment, and interpersonal questions about identity, belonging, and life direction.

The Myth of Inevitable Storm and Stress

A myth about adolescence is that it is a time of constant turmoil, conflict, distress, and confusion. To paraphrase Anna Freud, one of the proponents of this myth, the one thing we can expect to be normal about adolescents is they will be abnormal. G. Stanley Hall, a singularly influential American psychologist in the early 20th century, asserted that the adolescent years recapitulate the human species’ struggles to overcome savagery and applied the phrase “storm and stress” to adolescence.

Parents accept wholesale that the adolescent years inevitably involve personal chaos and interpersonal confrontation. Parents express astonishment when informed that cross-cultural, longitudinal research indicates that relative calm and peace mark adolescent development. There seems a willingness (a) to accept that something dreadful occurs when puberty ensues and (b) to expect inevitable conflict. It is as though parents consider the adolescent years the werewolf stage of human development.

National and international research studies about adolescent identity formation tell a different story than the plot line of endemic turmoil, conflict, distress, and confusion. Adolescents in many nations indicate satisfaction with their family life, appreciation for their parents, a sense of self-direction, acceptance of self, and good relationships with their peers. It is not that adolescents and parents never clash, but rather that these interpersonal conflicts do not produce self-doubt in the youth, resentment toward parents, or antagonism toward society. Adolescents, in short, on the whole describe their lives as primarily calm and satisfying.

A minority, around 20%, depict their lives as filled with personal chaos and interpersonal struggles. The minority of youth whose lives are filled with inner turmoil and acting out behavior come to the attention of the larger public, even at times to the attention of authorities. It has been hypothesized that, based on adults’ experiences with troubled teens, sweeping generalizations are drawn about the adolescent years being inherently problematic and conflict-ridden. The reality is that adolescents on the whole cope well with daily life. They impress researchers and school counselors with their resiliency in the face of life crises such as a death to a family member or a serious, even life-threatening, illness to the adolescent.

This book looks at the impact on adolescents of two challenging life events: (1) becoming seriously ill, even terminally ill; (2) grieving the death of someone cared for. We are learning more and more that the adolescent years are not protected from the onslaught of wrenching incidents that challenge coping. The prevalence of adolescents dealing with a life-threatening illness is relatively slight compared to the many youth whose lives are spared from being turned upside down by dreadful maladies. The prevalence of adolescents grieving the death of someone loved is higher than many persons realize; we know, for instance, that every year around 25% of all college undergraduates are in the first 12 months of bereavement due to the death of a family member or friend.

Development and Life Crises

Much of adolescent growth and development occurs as interplay with various internal and environmental demands—at times with serious life crises—and most adolescents meet these demands successfully. Influential models of human development emphasize the central place coping with life crises plays in growth and transformation for adolescents. Life crises present catalysts for growth and transformation, and a life-threatening illness and bereavement over the death of a loved one contain the structural features of any life crisis: fundamental challenges to well-being, coping, and assumptions about the world.

The influence of development during adolescence forms the back story when an adolescent copes with life crises due to a life-threatening illness or to the death of someone who mattered to the youth. In order to provide such adolescents the best support possible, counselors, clinicians, and others should understand adolescent development and how youth respond to the life crises of life-threatening illness and bereavement.

Phases to Adolescent Development

It has become useful in the past several decades to adopt the idea that adolescent development occurs in three phases: early adolescence, middle adolescence, and later adolescence (an idea introduced by Peter Blos in 1979). Distinctions between early, middle, and later adolescence have been instrumental in such practical outcomes as the creation of middle schools to ease students’ transitions from the elementary grades to high school. More recently the span of years called later adolescence is being termed “young adulthood” and “emerging adulthood.”

Early adolescence is considered to extend from approximately the ages of 10 to 14, and is marked by the onset of puberty. Middle adolescence extends from the ages of 15 to 17, and later adolescence extends from the ages 18 to 22. Of course, these age ranges are likely conditioned by Western cultural biases in developed countries. In some cultures, coming of age has no three-part phase of adolescent development; instead, boys and girls pass from childhood into adulthood when they reach puberty and can perform the tasks expected of an adult.

From the early through later adolescent years, it is expected that individuals will gain increased skill and competency to make career choices, enter into and maintain intimate relationships, and form an autonomous identity. In short, the developmental tasks adolescents are expected to master involve responsibility, interpersonal intimacy, and individuality. Underlying these developmental tasks lies a central question about coherent identity as a physical, emotional, sexual being. Of course, reaching the age of 22 does not propel one automatically out of the phase of later adolescence and into conscientious adulthood. Some persons throughout their adult years remain ambivalent about accepting responsibility, sustaining interpersonal intimacy, and forging a separate identity.

Tasks and Conflicts as Part of Development

In the mid 1980s, Stephen Fleming and Rheba Adolph developed a model that identifies linkage between developmental markers and issues that bereaved adolescents face. I have extended their model to include adolescents faced with a life-threatening illness. As Fleming and Adolph put it, “What is needed … is a model of grieving for adolescents that reflects the distinct and differing maturational levels of adolescence, one that offers insight into what happens to adolescent development when the conflicts of grieving collide with those of ego development” (Fleming & Adolph, 1986, pp. 102–103, italics in original). In this model, they identified tasks and conflicts all adolescents face.

Movement toward greater maturity can be measured by charting how well adolescents cope with tasks and conflicts endemic to each phase of adolescent development. These tasks and conflicts are discussed directly following.

• Early adolescents face the task of separating emotionally from parents and managing the conflict of leaving their family’s secure surroundings. They need to manage the tension created by the allure of remaining safe and the fear of being abandoned.
• Middle adolescents increasingly face the desire of achieving personal autonomy, self-efficacy, and individual control. Dependence on parents abuts against the adolescent’s interest to achieve independence. Thus, the task for middle adolescents is gaining a sense of mastery, and the conflict lies in the tension created over the press to be independent while in the push and pull of continuing dependence.
• Later adolescents’ level of success in mastering earlier maturational conflicts influences their struggles to achieve interpersonal intimacy and commitment. Coping with intimacy and commitment involves managing tensions over interpersonal closeness versus distance. Some individuals fear losing the independence they have achieved should they become overwhelmed by the demands of intimate, close relationships. Some remain ambivalent about the demands and expectations of intimacy and oscillate between commitment and running away.

Fleming and Adolph proposed that bereavement requires adolescents to cope behaviorally, cognitively, and affectively with five core issues. These five core issues are predictability of events, mastery/control, belonging, fairness/justice, and self-image. Additionally, the content of these behavioral, cognitive, and affective responses change according to the adolescent’s current maturational phase. All adolescents face these core issues. The death of a family member or friend or the actual threat of one’s own dying gives the issues special poignancy.

Adolescents dealing with the severe life crises of dying and of bereavement face not only the ambiguity and confusion of their situation but also the ambivalence stimulated by the push and pull of maturing or remaining immature. Resolution of this ambivalence occurs within the context of dealing with five core issues while also coping with the multiple manifestations of dread, anxiety, and fear. Directly following is a concise overview of how these five core issues play out for life-threatened and for bereaved adolescents in the early, middle, and later phases of adolescence. The author assumes that readers understand that the specifics within a particular adolescent’s life bring variation to this overall general template of behavioral, cognitive, and affective responses to each core issue. To help readers sort out the complexities of developmental phases and coping with the life crises of dying and of grieving, Tables 1.1, 1.2, and 1.3 summarize the central matters of cognitive, behavioral, and affective responses, respectively, to the five core issues.

Core Issues during Early Adolescence (10–14)

Cognitive responses. The early adolescent normally has a sense of being different from others, and this sense of being different is heightened when the adolescent is grieving a death or facing his or her own death. The crisis has shaken if not shattered the adolescent’s assumptions about the predictability of the world. The affected early adolescent looks to peers for acceptance and belonging, and asks questions about the fairness and justice of his or her situation (for instance, “Why was I singled out for this illness?” or “Why did that drunk driver escape unharmed but my sister died?”). The core issue of personal mastery and control may manifest for the bereaved youth in idealizing the person who di...