The death of an important person in an adolescent’s life may be the most stressful event that a teen could experience. Most teens conceptualize death as irreversible, inevitable and universal and that they too will die. Adolescents however, do not feel that death could be a reality for themselves or their peers; rather, the inevitable event is far off into the future.
Adolescents will court death with risk-taking behaviors or even death-defying endeavors. Yet they will not consider death as a serious possibility for themselves and will avoid discussions about it. As the teen winds his or her way through growth and development, the creation of a mature concept of death is modified by the adolescent’s personal experiences. Teens who have experienced the death of a friend or close relative have a different understand of death than those teens who have not had these experiences. Family, culture, religion as well as the teen’s level of maturity may also shape the concept of death.
If a parent, sibling, or other close relative has a terminal illness, some guidelines may help adolescents better cope with the situation. Teens are usually quite aware that the person has a fatal illness, and it is important to include them in discussions and visits with the close individual. To isolate the teen from information or the truth will initiate fantasy; fantasy may be far worse than reality. Adolescents are better able to deal with the known rather than the unknown. Research has shown that those teens who participate in end of life care giving, information and discussions cope better than those teens who were not included in these activities. It is less kind to distance teens physically, mentally and emotionally from a dying relative rather than have them face realities.
There is no absolute correct way to involve a teen with a dying relative. The proper mix depends on the dynamics of the family, the patient, culture, religion and other factors. The energy that a family devotes to informing and incorporating a teen into the dying relative’s life will result later in less distress, anxiety and acting out for the teen. Even though a family may be physically and emotionally exhausted from attending to the dying relative, it is appropriate to give time and energy to the adolescent who is also attempting to cope with the illness.
In most cases, adolescents should be allowed to attend a funeral if they wish if this is compatible with the family’s values and culture. Adolescents may desire to speak at a funeral, and the funeral may allow for some closure.
Grief may extend over a period of weeks to months and it will hopefully end when the teen accepts the death and completes readjustment. Shock, numbness, crying, sadness, anger, guilt, disobedience, loss of interest in school, sleep or physical problems, and decreased appetite are normal behaviors in teens after death of a close relative. Sometimes, the adolescent will relate better to his or her friends, compared to family.
The following may be signs that an adolescent is having difficulty with the grieving process especially if it occurs more than two months after a death:
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Decline in school performance
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Eating disorder
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Increasing risk-taking behavior including promiscuity
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Separation anxiety
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Depression and suicidality
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Sleep problems
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Persisting anger
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Conduct disorder
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Sleep issues
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Loss of interest in school or other activities
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Agitation or lethargy
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Loss of pleasure in activities that usually brought pleasure
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Suicidal ideation
If these symptoms are present, then referral to a mental health clinician may be appropriate.
Each member of a family will grieve differently and at his or her own rate. If a teen displays grief that is resolving, even if it is months after the death, then it is probably not pathological grief.
The death of a parent is extremely disruptive for a teen. Families must usually be reorganized. If a mother dies, then her role as a nurturer is lost and may be thrust on an adolescent daughter. This may interfere with the daughter’s social life or peer group activities. If a father is lost, then his role as the major breadwinner in many families may adversely affect the family’s finances. The mother or a teen may need to assume work to help pay expenses. The adolescent must not only cope with his or her personal feelings of loss, but changes may occur in their usual teenage life activities.
Teens may react to these changes with sadness, feelings of isolation from their peers and decreased school achievement. They may be angry about assuming roles in the family that mature them prematurely. It may be difficult for the teen to establish a new relationship with the surviving parent. And teens may grieve over the loss of peer friendships or changes in their life. A teen newly thrust into living in a single parent family with different finances may feel distanced from his peers and seek isolation. The intensity of these feelings will normally subside over months as the teen develops more future orientation. Of course, these feelings may reemerge on holidays, birthdays and anniversaries.
Since teens have a love-hate relationship with their parents, if a parent has a terminal illness, it is important that the teen help to make peace with the dying parent. If this is not possible or if the parental death is sudden, then the teen may have pervasive anger and guilt. If these feelings continue, then referral to a clinician is appropriate.
Adolescents live for tomorrow. Interest in the future and hopes for living remain high in terminally ill teens despite worsening illness and deteriorating body function. Since many adolescents do not have a long future orientation, then tomorrow is not too close, but next month is years away.
Dying teens wish to continue to be a part of everyday life. They want to stay involved in their illness and its management. They want information, encouragement and hope. They need time for privacy and reflection and time for angry outbursts. While cure may not be a possibility, liberal amounts of hope are really important to help adolescents deal with terminal illness. And when the time comes, parents should allow the teen to die as he or she wishes: at home or the hospital, in privacy or with relatives and friends, in quiet or music or with his or her pet or teddy bear.
Related topics:
Anger, chronic illness, depression, growth and development, risk-taking, terminal illness
