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Dorothy Judd, trained as a psychotherapist at Tavistock Clinic, worked with physically ill children whose life-threatening illnesses involved high-tech diagnostic and therapeutic procedures. The
book presents the clinical course and discusses the clinical, theoretical, and ethical issues surrounding the dying child.
The medical staff typically develops a protective distance and defensive posture toward dying children, leaving them and their parents emotionally unsupported and overwhelmed to the point of traumatization. Child therapists must assure high-quality emotional care, accompanying and at times counteracting the trauma of physical care. Judd immerses herself in the uncertainties of cancer therapy, confronting the moral and ethical questions of using hightech medical skills to prolong a life of pain, procedures, and debility despite negligible chances for survival. Her focus is that of the child's: the gradual realization of his or her fate, his or her own death.
Judd reminds us that the death of a young child is "an outrage against the natural order of things." Broadly reviewing our denying attitudes and taboos about death, Judd confronts the issues, using a Kleinian view of these phenomena: the death instinct, good and bad objects, persecutory anxieties, and the depressive position. Whether through manic defenses or idealization and transcendence, death is denied when one cannot tolerate the pain of loss. Judd confronts the theoretical/developmental paradox. Clinically, the preschool child sees death as temporary and reversible. The Kleinian preschool child uses the death instinct to develop death fantasies wherein the child then "feels that he has really destroyed the object …" (p. 24) and consequently fears retaliation from the object. Judd selected one hospitalized dying child, Bobby, to work with in psychotherapy, believing that answers and understanding will be found only through a psychodynamic approach rather than through direct interviews