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Theory and knowledge about children's awareness of the process of their own terminal illness and dying, and about how they express this awareness, is growing. Surveying the literature, Bertoia finds that since 1970 it has become evident that children do have an inner knowledge of their illness and impending death, and, if given the opportunity to express this, are relieved of their loneliness and fear, and have the potential to enter a process of inner emotional healing. Dying children can express their awareness in different ways, and there is a need for more knowledge about how this communication between children and adults can be accomplished effectively. There is also a need for more knowledge about the course of the child's growing awareness of the life-threatening nature of his/her illness. Bertoia refers notably to the theories and observations of Elizabeth Kübler-Ross, Susan Bach, and Myra Bluebond-Langner in these two areas of expression and awareness of death. Her study attempts to draw the relationship between existing theory and knowledge in this area and information derived from the works of one dying child, Rachel.
The data used are those of in-depth analysis of pictures drawn by Rachel during the last twelve months of her life, within the teacher-pupil relationship of her home tuition programme. Bertoia decided there was healing value in drawing after Rachel had, early in the series, changed the original title of one drawing from ‘Not feeling well’ to ‘Not feeling bad’, after having ‘got it all out in the picture’ (Rachel's words). In this they both follow Jung, whom Jaffé quotes as saying ‘Images should be drawn or painted assiduously no matter whether you can do it or not’ (Jaffé (ed.) Word and Image, 1979). The data are supplemented by information from medical records about her physical condition, and from her mother's journal, recording some of her conversation and behaviour. Standard symbol dictionaries are used to understand the arch