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Children facing terminal illness possess a mature understanding of death, similar to adults. Allowing them to discuss death provides crucial support and companionship, validating their life experiences.
Area of Science:
- Pediatric Psychoanalysis
- Thanatology in Childhood
- Palliative Care Psychology
Background:
- Children in pediatric nephrology wards frequently confront discussions of mortality.
- The capacity for understanding death develops early and does not significantly progress with age once verbal expression is achieved.
Purpose of the Study:
- To explore children's cognitive and emotional responses to the concept of death.
- To investigate the impact of adult communication (or silence) on a dying child's psychological state.
- To define the essential needs of terminally ill children, particularly the need for recognition and companionship.
Main Methods:
- Qualitative analysis of psychoanalytic observations and conversations with children in a pediatric nephrology setting.
- Exploration of children's expressed thoughts and feelings regarding death and dying.
Main Results:
- Children, once able to articulate their thoughts, demonstrate a clear-eyed understanding of death comparable to adults.
- Despite this clarity, children employ defense mechanisms against the idea of death.
- Adult silence leads to child isolation; conversely, open communication and recognition are vital for the child's well-being.
Conclusions:
- Terminally ill children's ability to discuss death is intrinsically linked to their ability to discuss life.
- The most significant support for a dying child involves acknowledging their reality and staying with them until the end.
- Recognition near death is paramount for children facing mortality.
Abstract:
As a psychoanalyst in a pediatric nephrology ward, I have listened to children talking about dying and death. As soon as a child can express himself freely on this subject, no further age-dependent progress concerning the concept of death can be observed. Faced with disease and death, the child is led to the same images and conclusions, to the same order of ideas as the adult. This clearsightedness does not prevent the appearance of mechanisms of defence against the idea of death. Faced with the silence of the adult, the dying child shuts himself up in loneliness. However, the child does not want to be alone: he craves to be recognized. During the time left before his death, to be recognized is for him synonymous with: "to be recognized near death". To let a child talk about his death is to let him talk about his life, to bring him the only possible help, that is, to be with him till the end.