Exploring the Grief of Adolescents After the Death of a Parent

BARBARA KUNTZ, PhD, RN, CS

This study explored the grief of 26 adolescents after the death of a parent during the subjects’ adolescent years. Data collection involved a one-time semi-structured interview. In addition, the adolescents were asked to write and draw about death. The study identified variables and themes that appeared to have possible significance for how adolescents coped. The study conclusions were that adolescents do grieve differently from children and differently from adults; younger adolescents even grieve differently from older adolescents. No discernible differ- ences in grieving were ascertained on the basis of sex, type of death, or prior loss experiences. The one adolescent who was perceived as grieving in an adaptive manner had the advantage of open communication with family members, had closure with the parent now dead, had seen the parent when dead, and had been involved with the rituals surrounding the death. Implica- tions for future research and recommendations for adults involved with adolescents are included.

LTHOUGH DEATH has become an increasingly ac- cepted topic for study and discussion, it is still often A denied, ignored, or considered taboo by many intel-

ligent adults. This is true despite the fact that theorists have delineated phases of grief, grief tasks, and some bereave- ment resolution (Bowlby, 1980; Engel, 1962; Freud. 1917; Kubler-Ross, 1969; Lindemann, 1944; Parkes, 1972; Wordon, 1982). There even is a delineation of how a child grieves (Bluebond-Langner, 1978; Nagy, 1948; Raphael, 1983). But do we know the impact of a death on an adolescent? Specifically, what do we know about how an adolescent grieves after the death of a parent?

One of the most difficult issues for all is the death of a mother or father. The eventual death of a parent is accepted as inevitable, but it is presumed that this death is likely to occur when the offspring is an adult, late in life. What happens if the death occurs during achild’s adolescent years?

The adolescent years are turbulent under the best of

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Accepted for publication December 20. 1990. 21043.

From the Walter P. Carter Center, Baltimore, Maryland.

circumstances. When a parent dies between a child’s 12th and 22nd year, the effects can be devastating. This could well be the first death the adolescent has had to face. Until then, the child’s attention has been focused on school, friends, sports, music, and other areas of particular interest. How are young people equipped to deal with this overwhelming occurrence so foreign to their experience’?

The general concern of this study was to explore how an adolescent grieves. The specific concern was to explore the grief of adolescents after the death of a parent. The need for this specificity was indicated by the fact that little research has been done on the grieving adolescent. The research available deals with the death of a sibling (Adams & Deveau, 1987; Balk, 1983; Banks & Kahn, 1941; Donnelly, 1988). While there are not many studies that attempt to understand the adolescent’s view of death, there are fewer still that explore the grief of adolescents after a parental death. Most often, research on the death of a parent focuses on the emotionally disturbed child and adolescent: or the emotion- ally disturbed child and adolescent population have been combined together (Furman, 1974; Hilgard, Newman, & Fisk, 1968). Frequently, the data were gathered through interviews with the remaining parent, not the adolescent. The danger therefore, exists that assumptions and generalizations for adolescents were based on little clear. direct, or factual data.

The death of a parent during the ages of I I to 22 is a dreaded loss and one with a low risk of occurrence. How- ever, Osterweis, Solomon, and Green ( I 984) reported that an estimated 5 % of children in the United States (1.5 million) will lose one or both parents by age 15. This developmental stage is the time when an adolescent is struggling to deal with sexuality, ambivalence, identity, dependenceiindependence, and separation from parents, and needs parental guidance.

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While there are not many studies that attempt to understand Procediires the adolescent’s view of death. there are-fewer still that explore the grief of adolescents after a parental death.

The concept of bereavement used in this study was based on the work of Bowlby (1980) who delineated differences between children’s and adults’ mourning. Bowlby‘s phases of the grief process include numbness, yearning and search- ing, disorganization and despair. and reorganization. Bowlby believed the phases of grief can be recognized in people of all ages, even children as young as 6 months of age.

This study explored how an adolescent grieves. how adolescent grief differs from the grief of children and adults. whether there is a sex and age difference, how Bowlby‘s phases of grieving manifest themselves. and how the factors that influence the grieving process apply to the adolescent.

Method

This exploratory study was qualitative, retrospective. and concurrent. Field and Morse ( 1985) stated that qualitative research methods use inductive, holistic, subjective. and process-oriented research methods to understand, interpret. describe. and develop theory pertaining to a phenomenon or setting. The qualitative method is appropriate for research when the phenomenon studied has undergone little empirical examination and thus requires an exploratory. descriptive method (Glaser & Strauss. 1967).

Sariiple

The sample was a convenience sample. Participants were obtained from among clients of bereavement services offered to the community; referrals from clergy. therapists. and former nursing students: and self-referrals. After a referral had been received. a letter stating the proposed research was sent to the surviving parent. This was followed by a phone call 10 days later. At that time. permission to approach the adolescent was requested. The adolescent was then asked to be in the study, and an interview time was determined. Of the 27 adolescents contacted. 26 agreed to be in the study. The majority of the interviews took place in the home office of the investigator.

Participants included 1 1 females and 15 males; 24 cauca- sians, and two black adolescents from middle to upper middle income families. Thirteen parents died from a termi- nal illness; 13 had sudden deaths. The time since the parent had died varied from six weeks to six years with a mean of 2 years, 7 months. Each participant was interviewed by the researcher. Of the 26 interviewed, 12 were known to the investigator from their having been in a hospice Teen Support Group. Interviews were tape recorded and averaged two hours in length.

lareniew. A semi-structured interview was constructed on the basis of a review of the available literature from which data had been gathered regarding the determinants of grief and its manifestations. Specifically, the participants were assessed regarding their prior loss history, their position and role in the family, coping behaviors, grief behaviors. and rituals involved. In addition, they were questioned as to the effect of church, school, and peers as supports during their grieving time. From these situational variables, themes heard paralled Bowlby’s phases of mourning. The items included questions about the time of diagnosis of the deceased parent’s illness to the time of the interview.

Writtell Cornpasirion. The written composition exercise was conducted early in the interview to gain impressions before the participant was influenced by the researcher. The exercise investigated what adolescents think concerning the nature of death. All adolescents were instructed to write down everything that came into their minds when they heard the word “death.”

Dmiing. After the adolescents had written about death, they were asked to draw what came to their minds when they heard the word “death.” They were then asked to give a verbal commentary on their picture. The rationale for the use of art work is based on the work of Kramer (1977) who believed that art therapy is a means of supporting the ego. fostering the development of a sense of identity, and promot- ing maturation. She further stated that every child has creative drives if encouraged in an atniosphere of controlled freedom. This allows for growth, satisfaction, and increased ,elf-esteem. Doing something active and creative in this world of increased mechanization is in itself therapeutic, or in this situation, self-healing. The value of art work with grieving seems to be the ability it gives to individuals to express themselves in another manner. The drawing exercise also served to validate what was said in the interview and, more specifically, to correlate with what subjects had written in the write-about-death assignment.

Data AiialFsis

Once the interviews were completed, a content analysis followed. There are no explicit rules for analyzing qualitative data. Patton (1980) stated, ‘‘ . . . that for particular outcomes no acceptable, valid, and reliable quantitative measures exist for qualitative methods. In the art of social science it is a fact that a number of desirable outcome measures still elude precise measurement” (p. 72). Becker (1970) gave guide- lines for a content analysis. Content analysis is a method that has been devised for yielding objective and systematic descriptions of communications and written materials.

The analysis of qualitative materials usually begins with a search for themes. This thematic analysis looks for themes

ADOLESCENT GRIEF KUNTZ 107 that emerge in relation to other variables: essentially a search for commonalities among people and for differences across subgroups. The relationship between the parent and the adolescent is generally not a mature, seasoned one. The hesitancy that characterized the relationship when the parent was alive gives rise to a wide range of emotions after the parent’s death. Consequently, the adolescents’ communica- tion must be carefully interpreted. Multiple means of expres- sion, including drawing, writing, and conversing, were used to more fully grasp the adolescent messages.

Repeated readings of all compositions occurred during which notes were made of similarities and differences, and themes or categories. Examination for correlation with draw- ings also occurred.

The drawings were analyzed and coded according to themes delineated through interviews. This involved thor- ough and repeated viewings of all drawings, enabling differ- ences and similarities to be noted (DiLeo, 1977). The adolescents’ comments validated what they had drawn. The inter-rater reliability between an art therapist and the re- searcher was consensus on all drawings reviewed.

Results The death of a parent is a crisis situation for any age. The

adolescent who has had a parent die reacts to the crisis in different ways. Although obvious, the fact bears repeating that all of us react to stress, loss, and crisis according to our own prior experiences, values, and perception of the event. However, recurrent themes were delineated. Themes are those underlying issues or problems experienced by the adolescents that emerged repeatedly during the interviews with the bereaved adolescents. Themes can relate to feelings or behaviors or experiences.

Sometimes themes were a quantitative matter; sometimes a qualitative matter. For example, for the theme of with- drawal, no adolescents stated that they withdrew; rather, when relating their feelings and behavior after the death, the theme of withdrawal is what was heard. Sometimes, themes were quantitatively important. For example. under yearning and searching, the themes of fearfulness came through with most of the adolescents; seven feared the death of the surviving parent, six were fearful for their own health, and five were fearful of failure at school.

The themes that emerged from the interviews were with- drawal, fearfulness, aloneness, chronicity of grief, sadness, unpreparedness, presenting of facades, lack of guilt, in- creased resilience, instant maturity, honesty with thoughts and emotions, achieving closure, and awareness of support systems. Not all adolescents displayed all of these themes. Also, the themes were expressed in different ways. The adolescents’ accounts of reactions to the situation of a parental death were observed and recorded.

Samples of comments that helped delineate themes were:

“I’m scared my mom is going to die also.” “It really bothers me that my mother won’t be there for my wedding.” “I was surprised she died, I always thought she would get better.” “When I went back to school, I wasn’t sure who knew dad had died, I was relieved when no one said anything.” “I have matured, aged, and become very independent.” “My mom’s death has made me appreciate my dad more.” “My father called us in one by one to say good-bye.” “Several days before she died we had a quiet talk.” Guidelines that formed the framework for the interpretation of adolescent responses were derived from several sources, including the determi- nants of grief and the manifestations of grief. Bowlby’s phases of mourning were examined by exploring the adoles- cent’s loss history, family structure, school, church, and support systems.

Keeping in mind that it is impossible to generalize from the samples of 26 adolescents, the conclusions are summarized as follows: adolescents do grieve differently from children and differently from adults; younger adolescents grieve differently from older adolescents; and no great differences were noted to suggest that boys grieve differently from girls. The phases of grief of the adolescent manifested themselves individually and were identifiable as phases of Bowlby’s schema. The experience of eliciting the loss history did not yield sufficient data to confirm this as a factor to be analyzed as this age group proved to be poor chronologic historians. The data generated did not suggest that the type of death was a factor.

Differences in Adolescents’ Grief

The adolescent grieves differently from the child in that the adolescent comprehends and believes that death is inev- itable. Adolescents believe death is a universal happening and that it can happen to them and to their loved ones (Bowlby, 1980; Nagy, 1948). One of the findings of this study is that the adolescent appears unburdened by the guilt or a feeling of responsibility for the death of the parent that often concerns the child. As the adolescent’s grief differs from the child’s, so does it differ from the adult’s. Adoles- cents grieve as adolescents. Thus, as shown from their statements, adolescents felt different from their peers; they felt suddenly grown up, more mature. This theme was named “instant maturity.” This finding concurs with results of a study by Berman and colleagues (1988) in which the surviv- ing parents noted that their adolescents had matured.

The adolescent grieves in some ways like an adult, yet in other ways differently since grief is individualized. The adolescents manifested the grief process in ways that re- flected Bowlby’s phases, which are an acknowledged mourning process for adults. However, one impression is that adolescents attempt to outwardly speed up the grieving process and to mask much of what is occurring. This speaks to presenting facades, which required additional effort to act

108 JCPN VOLUME 4 NUMBER 3 1991

as though all is okay; that is, that they are no different from their peers.

Numbness Phase

According to Bowlby, there is numbness, shock, and some denial during this phase. Characteristic of this phase is going through the motions although the person has "shut down" emotionally, and perhaps physically as well. This self-preservation, adaptation response allows individuals who have had traumatic news to enter a trance-like state in which they absorb the traumatic news as they (emotionally and physically) can handle it. This first reaction may last from hours to a week. The person can go in and out of the numbness stage.

The theme heard during this numbness phase was one of withdrawal. Tasks during this phase for the adult include letting the world know the death has occurred. The adoles- cents interviewed generally did not do this. However. two older males called girl friends, and one older female had to take over and inform family members of her father's sudden death when her mother was unable to function.

Yearnin8 and Searching Phase

This phase of yearning and searching applies to all age groups, but especially to the adolescent. Adolescents wish that the now-dead parent could be there to attend their graduation, wedding. or the birth of children. This yearning phase also includes some regrets that are manifested by wistful statements. such as "I wish we had been closer." and some ambivalence: "How could he leave without saying good-bye!" In this phase, there may be an element of relief. Relief after the death of a loved one occurs when the death and relief of physical pain is perceived as better than the painful, ongoing dying.

The searching aspect of this phase is manifested when the grieving person is preoccupied with thoughts of the dying or dead person. The person may be physically restless. There is a great urge to recover what is no longer there. Bowlby (1980) pointed out that the effort to recover may lessen, but never cease. Feelings during the yearning and searching phase may include sadness. anger. guilt, shame, and ambiv- alence. There are no inherent values attached to feelings, that is, one is not better or worse than another. The themes expressed by the adolescents indicative of this phase were aloneness, fearfulness, and chronicity of grief.

Crying is characteristic of the yearning and searching phase. The adolescents stated they usually cried alone in their beds at night. Whether the crying is in a solitary fashion to save face or to protect other family members or to appear no different from peers has yet to be determined. Adults tend to cry more openly. Dreams are also characteristic of this phase (Bowlby, 1980). While adolescents do dream of the dead

parent, they rarely relate sensing the now-dead parent visu- ally or auditorily as adults do.

Still differentiating between adolescent and adult grief in the yearning and searching phase, adults may display anger and hostility. Anger was felt from the adolescents-they wrote about i t , they drew about it-but they rarely talked about anger. For the adolescent, it came out more as anger at being abandoned. Thus, anger was not directly verbalized but was expressed as they shared their daily frustrations about lack of transportation or about chores required of them.

Disorganization and Despair Phase

Grief "work' is appropriately named as it is hard and demanding; it leaves little energy for the adolescent to apply elsewhere. Often, the concentration required for school tasks is not there. Individuals in this phase display a great amount of disorganization. Despair is not apparent visually but occurs as a bleak state of mind. Despair is when the person thinks that the worst possible event has occurred. The person may become depressed. At the depths of despair, the person may contemplate suicide, as an option to end the pain or to rejoin the dead person.

The themes delineated for adolescents during this phase include sadness, unpreparedness. and presenting facades. For adolescents, there is a phase of disorganization and despair, but they appear to go to great lengths to hide it. Adults do not. Adolescents also seem to progress through this phase quite rapidly. They give the impression that, although this may be a part of what they have to go through, for their own self-preservation, they have no intention of staying in this phase.

Reorganization Phase

Bowlby's final phase is one of reorganization when the bereaved works through attachments to the deceased person and begins to establish new links to people and events. The themes delineated for adolescents during this period are lack of guilt. increased resilience, instant maturity, honesty with thoughts and emotions, achievement of closure, and aware- ness of support systems. As with an adult, the adolescent can go through some phases in 5 minutes, but then be stuck in one phase for several months. They do seem to unconsciously work toward the phase of reorganization. The adolescent seems to anive at this phase more quickly than adults; a new life with strong new attachments begins. Observers in this phase see better school performance, attentiveness, and more autonomy.

Directions for Further Research

This study was limited to the bereavement period of adolescents following a parental death. These findings should be validated through further study that includes a

ADOLESCENT GRIEF KUNTZ 109

larger number of adolescents in a longitudinal study. In an ongoing study, there would be the opportunity to include instrument assessments and to interview members of the bereaved adolescent’s support system. Additional research also should be conducted on subjects from a variety of geographic locations and from different socioeconomic, ethnic, and religious backgrounds. Further areas of study could evaluate whether bereaved who have had formal death education, counseling, or support group involvement resolve their loss better or more rapidly than those who have not. Also, further study will ascertain if there is a relationship between the sex of the bereaved and the way adolescents grieve and resolve their grief.

In an ongoing study, it might prove helpful to correlate data from the parentally bereaved with those not parentally bereaved as an adolescent. Additional research also could determine if reactions of adolescents from sudden and linger- ing deaths are the same as those where death is a result of homicide or suicide. Other research areas are evaluation of long-term effects of mental or physical illness of the surviv- ing parent, the health of the adolescents as they mature, their accident incidence, and the stability (e.g., socioeconomic and religious) of the family system before and after the death. This further research could result in the development of an instrument to predict a resolution of the bereavement phase. To achieve this predictive phase would allow for diagnostic and preventive interventions.

Clinical Implications The study has implications for nurses in any setting where

they have contact with adolescents. This study, although designed for the parentally bereaved adolescent, evidenced commonalities that can be applied to all grieving adoles- cents. That is, adolescents proceed through their grief in their way, according to a time table dictated by their situation, personality, and circumstances. The fact that in this study adolescents volunteered as early as after 6 weeks of bereave- ment and also after 6 years of bereavement demonstrates not only the ongoing quality of their grief but their desire to help themselves as quickly as they could.

Any nurse (school, hospital, emergency room, pediatric, or community) therapist who is aware of a pending or sudden death and has an awareness of the family composition is in a position to intervene in a positive, contributory way. A death is a crisis situation, and nurses can intervene by providing support learned through death education. As a result of this study, supportive, educational counseling should be offered to all bereaved children and adolescents through group work or on an individual or family basis. If the nurse is not prepared to intervene, referral to other professionals is appropriate.

The grief of the adolescent after the death of a parent is a psychological area of concern that is slowly gaining atten- tion. While this qualitative study in adolescent grief did not reveal any nonfunctioning adolescents, it did demonstrate the need not only for more research but for direct intervention in the area of education, crisis intervention, counseling, and bereavement intervention.

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