1. How Children Make Meaning of Illness and Suffering and Why It Matters

2. Paul Thayer Wheelock College

3. Session Outline Introduction How children understand illness and death, and why it matters How children understand ethics and why it matters How children understand suffering and why it matters Closing comments

4. How are we sometimes limited in our understanding of coping and spirituality?

5. Children and Coping Emotional-based coping Play-based coping Information-based coping Decision-based coping Meaning-based coping

6. Information-Based Coping Understanding Illness Bibace and Walsh (1980) Understanding Death Thanatos (1995)

7. Understanding Illness and Death: Infants No real understanding Encounter issues of separation, pain, environmental stimulation, safety, caregiver transitions

8. What Helps: Infants Parental presence in induction and recovery Security objects Adequate pain management Attention to lights and people in the room Routines Treatment rooms for procedures Attention to lunch time and shift changes

9. Understanding Illness and Death: Pre- Schoolers Phenomenism Contagion Death is temporary and reversible Death mixed up with sleep

10. What Helps: Pre-Schoolers Everything for infants Brief explanations before procedures Choices Correct magical thinking

11. Understanding Illness and Death: School Age Contamination and internalization Beginning to master the concepts of non- functionality, irreversibility, and universality

12. What Helps: School Age Everything for pre-schoolers Control Explanations of the illness process Ask about guilt and punishment

13. Understanding Illness and Death: Teens Physiologic processes Psychophysiological processes Adult understanding of death

14. What Helps: Teens Everything for school age Peer contact Participation in decision making

15. Why Information-based Coping Matters Misinformation or misinterpretation leads to fear Information needs to be matched to developmental stages and capacities Maslow’s Hierarchy: If issues of safety, security, pain management, and basic questions about what is happening are not addressed, it is difficult to move on to anything else

16. Why Information-Based Coping Matters Kids often “know” more than they understand Our explanations need to grow up with them The luxury of time

17. Decision-Based Coping: Ethics

18. What is Ethics to a Kid? Immediate concerns “Small” concerns Egocentric

19. Why It Matters How We Understand Ethics Responding to tone rather than content Failing to hear the ethical message Shutting down conversation by being prematurely comforting

20. Meaning-Based Coping: Interpretation, Significance, and Narrative

21. What is suffering? Suffering is a threat to the integrity of a person as a complex psychological and social being; suffering is experienced by persons, not just their bodies – Cassell 1982

22. Meaning Making and Spirituality Suffering is a challenge to meaning that calls for a meaning-making response Suffering is an intrapersonal spiritual issue that calls for an interpersonal spiritual response

23. What is Suffering to a Kid? Loss of wholeness Loss of a significant person Loss of identity Loss of friends Loss of routines

24. Kids and Meaning Construction Meaning making by proxy Meaning construction Meaning reconstruction – Assimilation – Accommodation

25. Some Meaning Reconstruction Questions What have you been taught? Do you believe it? Does it make sense to you? What do you believe? What do you believe differently now that this has happened to you? What do you wonder about?

26. Concluding Remarks Many kids who are not in spiritual distress also need our help and presence We are often too invested in being cheerleaders or closure fairies We often miss chances to help because we focus only on emotional coping

27. Concluding Remarks Spirituality doesn’t just happen, it is co- constructed: – Feelings – Imagination – Questions – Decisions – Interpretation

28. Concluding Remarks Being in the Zone of Proximal Spiritual development