Helping Children Cope with Dying

My interest in dying children and in the special tasks and stresses which that part of their lives engenders for them and for us, began almost thirty years ago. I was then asked by a paediatrician to see his eight-year-old blooddiseased patient in the hospital and to initiate a psychotherapy with the boy that would help him with recently developed emotional difficulties. Kevin had been a fairly cooperative patient for a couple of years but had currently turned whiny and negativistic, unwilling to eat, to exercise, to participate in the ward's play and activity group. He resisted taking medication, refused prescribed treatments, even when urged to do so by his devoted parents, and displayed a sullen, hostile mood with everyone. The doctor, staff and family were especially distressed about this change because they felt so hopeful about new and different approaches to Kevin's leukemia. They viewed his frustrating lack of cooperation in part as stubborn resistance and in part as a neurotic reaction to the stresses he had undergone. They felt it was too bad that all this was happening “just now when he needs to keep up his strength to get better”.

I found a very pale, thin, tightlipped youngster who greeted me with a mixture of apathy and suspicion. As we got to know one another in consecutive, largely silent sessions, he came to trust that I would neither jolly nor force him into unwelcome activity and he could ask me for small services that would help to alleviate his discomfort or divert his mind from it — a pillow to prop up his bent aching legs, a few cartoons to leaf through, a glass of water. I, in turn, came to understand that his “resistance” was neither a sign of contrariness nor of neurotic conflict. It was the natural consequence of his dying. As his pleasure in living functions ebbed away he had come to focus only on avoiding pain and on protecting himself against excess stimulation from within and without to achieve a tenuous inner equilibrium of relative pe