When Father Kills Mother

Guiding Children Through Trauma and Grief

Jean Harris-Hendriks, Dora Black, Tony Kaplan

• Publisher: Routledge
• Year: 2002
• ISBN:
  9781134644315
• Edition: 1
• Topic: Psychologie
• Subtopic: Psychothérapie

Children bereaved by the death of one parent at the hands of the other, almost always the father, in effect lose both parents, and are often forgotten in the midst of such dramatic situations. Reflecting the increased interest in child protection and child law systems, this second edition of When Father Kills Mother brings to public knowledge, in amplified form information about the effects of psychological trauma and bereavement on children. By combining knowledge about bereavement with that of post-traumatic stress disorder, the book remains informative and essential reading for all those involved in the field, both professionally and personally.

Part I
Violence and loss in childhood

Chapter 1
Children and trauma

Sombre the night is
And, though we live our lives, we
Know what sinister threat lurks there.
(Isaac Rosenberg, ‘Returning, we hear the larks’)

SUMMARY

The concept of post-traumatic stress disorder is discussed historically and with reference to recent research. Disaster caused deliberately by fellow-humans is sometimes more difficult to comprehend than natural catastrophe. Adults who wish to protect children may have difficulty in recognising traumatic stress in children. Its effects are described and discussed so that children’s suffering may be brought to light. This chapter may be read in conjunction with Appendix 3.

Historical overview

Two Czech writers outlined the history of childhood experience of traumatic and destructive events, dividing this history into four periods:130

1. The empirical period: 1850–1930. Doctors who worked with children drew attention to the high incidence of both death and the slowing down of intellectual and physical development in children housed in institutions, particularly orphanages and hospitals. Writers at this time focused in the main on the need to improve the physical environment, particularly sanitary conditions.
2. The alarm period: this did not begin until the 1930s and 1940s. Large numbers of children were wandering through Europe, deserted by or separated from those who cared for them, dislocated and rootless. Writers began to express concern about their emotional, mental and physical development and the effects upon children of imprisonment, malnutrition, concentration camp experiences and loss of family, community and education. During this period there was also worry about working women, poor housing and the high incidence of breakdown in wartime marriages. Studies of infants in institutions indicated that children who survived this kind of upbringing were under-stimulated, with difficulty in learning and in developing trusting relationships.²⁰⁹
3. During the third period were the beginnings of evaluating what was known and drawing conclusions from it, characterised by the work of Bowlby, which he overviewed in 1979.³⁷– ³⁹
4. During the fourth period, the 1960s and early 1970s, there were advances in systematic research on the effects upon children of separation and dislocation. All of this preceded and, with hindsight, has provided a framework for, work specifically on the effects of trauma upon children.

The problem for all of us who study the effects of dreadful events on children is that both historical accounts, as indicated above, and recent research tend to blur together negative effects (loss, hunger, neglect) with the results of positively dreadful experiences such as assault, torture, threat to life, seeing loved ones going through such experiences, or witnessing homicide. Today, when we try to understand the effects upon children of traumatic events, a pool of knowledge exists which ranges from the study of deprivation and neglect in the context of war, civil unrest or institutional care, to neglect within families.⁶¹ We know a lot about what is needed to enable children to become securely and safely attached to those who care for them, and about how horrifying events affect both mind and body from childhood onwards. We develop these themes in future chapters.

Until as recently as 1985 there was considerable scepticism expressed within the psychiatric establishment that children reacted even to overwhelming stresses with anything other than mild and transient emotional and behavioural changes. In the second edition of the standard British textbook on child and adolescent psychiatry, Child and Adolescent Psychiatry: Modern Approaches, ⁸¹ it was said with regard to the effects of severe stress upon children that:

behavioural disturbances appear to be less intense than might have been anticipated; a majority of children show a moderate amount of fear and anxiety but this subsides; regressive behaviour marked by clinging to parents and heightened dependency on adults appears and then moderately mild sleep disturbance persists for several months; a later less severe stress such as a storm may lead to a temporary increase in emotional distress, although this is variable; enuresis (bed wetting) occurs in some cases, while hyper-sensitivity to loud noises may be evident in others.

(p. 126)

The received view, based on clinical and research evidence, was that major disasters might lead to emotional disorders which would be a handicap to some children but that usually these disturbances were short-lived. This perception was reflected in the authors’ assertion that there was no need for a specific diagnostic category for stress-reactions in childhood such as was used in adults.

Until that time the difficulty was that studies had rarely dealt with the effect of major disasters on children who had been at risk of their lives or who had witnessed death and destruction. We now know that post-traumatic stress symptoms, in common with other changes in the child’s emotions, often go unrecognised or at least underestimated by the adults in the child’s life. In 1987, after the Herald of Free Enterprise ferry sank off Zeebrugge, it was suggested that earlier studies failed to identify the extent of children’s difficulties after exposure to traumatic events because many had not used screening instruments which picked up post-traumatic stress disorder (PTSD) symptoms, and because they relied on parent and/or teacher reports, and therefore underestimated the level of children’s disturbance.²⁶⁴ Another factor which may be important is that, as in bereavement, the adults themselves may be preoccupied by their own distress and therefore less able to recognise distress in their children.

In part, it is because adults are understandably very protective towards children who have survived a disaster; and in part it is because adults, unwilling to acknowledge what children may have suffered, deny that children have major psychological sequelae that warrant investigation.264

(p. 279)

The third edition of the standard British textbook referred to above has a chapter on posttraumatic stress disorder.¹⁹⁷ There is still some controversy about the diagnosis of posttraumatic stress disorder. It is not the only response to trauma.

We now speak of the ‘conspiracy of silence’: adults try to protect the children by not speaking of terrible events, hoping that the children will forget or supposing that, if they do not initiate discussion, children are best left alone. Children, on the other hand, more in need than ever of care and nurture, may fit in with and confirm the illusions of the adults by masking or at least remaining silent about their distress, not wanting to upset their carers.

Our current knowledge

In fact, children suffer the effects of traumatic stress in very similar ways to adults. Posttraumatic stress disorder (PTSD) in children has now been studied in relation to witnessed violence, rape and suicide,¹⁷⁹ parental murder,¹⁴³ kidnapping,^{220, 221} bushfire,¹⁴⁶ child abuse,^{89, 92} natural disaster,⁹³ major transport disasters,²⁶⁴ community violence,²²² child murder²⁴⁸ and domestic violence.¹⁵⁶ Studies of the effects upon the siblings of traumatised children, hitherto little studied, are reviewed by Newman and his colleagues with particular reference to illness, disability and death;¹⁶² the effects of crime and disaster require further study.

Like adults, children suffer more intensely and persistently when the catastrophe they witness is caused by a person or people rather than resulting from a natural disaster (see, for example,¹⁸⁸). In a study at a crisis centre in Los Angeles, nearly 80 per cent of more than 100 children who had witnessed extreme violence inflicted on a member of their family had characteristic symptoms of post-traumatic stress.¹⁷⁹ The same team studied the effects of a sniper attack on schoolchildren in their playground. The sniper was a man who had lost his own family in a mass suicide. Some children were killed. The team found that the children most profoundly affected by post-traumatic stress symptoms were those who had been most at risk for their lives and least protected by an adult. The further away the children had been from the scene of the fatal shootings, the fewer symptoms they showed. Children in other parts of the school, on their way home, at home or out of the neighbourhood, were sequentially less affected and had fewer if any post-traumatic stress symptoms.^{181, 182}

This was the first study in which the symptoms of post-traumatic stress in children were systematically and comprehensively catalogued and the direct effect of the stress demonstrated beyond doubt. The authors were able to show, for example, that the children who had been most at risk were almost invariably more profoundly affected than others who were more protected or further away, and that the intensity of the reactions had very little to do with whether the children had been exposed to violence previously, recent major events in their lives or their age or sex. Conversely, the influence of these factors was much greater in those children who had not been in the playground but who developed symptoms later. Interestingly, children who had been exposed to previous violence were not in the main resistant to further stress; if anything, they had been sensitised to violence and their reactions were made stronger by a reawakening of memories related to the violent events they had previously witnessed.

The symptoms of these schoolchildren were by no means transient. Just over a year later, three-quarters of those children who had been in the playground at the time of the attack were still suffering symptoms of PTSD. It was clear that those who had been most in danger of being shot and the most intensely affected at the time went on suffering the most. The less exposed children who still had symptoms had in common a strong sense of guilt, for example about not having done enough to protect younger siblings or friends. Yet severe and persistent grief was related hardly at all to whether the children had felt their own life threatened. As one might expect, it had much more to do with how well they knew the victim of the attack. There is the possibility, however, that the grief of some children who had been severely traumatised may have been masked or inhibited by their PTSD symptoms,¹⁵⁸ a theme illustrated, again and again, by children in our study. We are now seeing the longer-term effects of unresolved trauma on children who, never having grieved, have difficulty in trusting those who now try to look after them.

Much of our current knowledge about traumatic stress comes from the assessment of, and interventions with, children and their families in war zones. As a society, we have been slow to recognise the detrimental effects of war on children. Women and children increasingly are involved in war, especially in the developing world, where they form a large proportion of the population.

Iraqi children who had seen and heard multiple deaths in a bomb shelter have said: ‘I feel trapped by these memories.’ ‘My parents don’t know what I am going through. They say, “Try to forget it.”’ ‘This year I don’t think I will be able to pass my exams.’ ‘I feel that anything might happen.’ ‘God might take my life and I never know when I am going to die.’ The effects of stress on these children were comparable with those in other disasters.⁶⁵ In an extensive study of affected children in the Lebanon,135 Macksoud established that, as might be expected, effects were cumulative: the higher the exposure to violence, the higher the incidence of PTSD. Bereaved and displaced children described their feelings of helplessness and their attempts to make plans, to take control of their own lives. When asked to select the most painful of their memories, 60 per cent listed the death of someone close to them. Traumatic stress, with underlying grief sliding into depression, became a part of daily life, although resilience, attempts to plan their lives and strong community ties afforded some support.

In Bosnia, children who had suffered earlier separations were most vulnerable to traumatic stress, depression and associated problems of behaviour.²³² Those with greater symptoms had witnessed the death, injury or torture of a member of their nuclear family, were older, and came from a large city.⁸⁸ During 1980–6, Dalianis-Karanbatzakis followed up children whom she had known in Greece during the Civil War of 1946–9 when she was imprisoned along with children and their mothers.⁵⁶ This study is particularly helpful in identifying factors related to resilience and survival in the aftermath of extreme events, and we discuss this valuable research further in Chapter 10.

Children who are refugees may have an additional stress. They may become protectors and providers for their parents, receiving bread and other sustenance in preference to adults, so that the latter become dependent on their children. Maturation ...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Preface: Confidentiality
• Acknowledgements
• Introduction: How We Came to the Work
• Part I: Violence and Loss In Childhood
• Part II: When Father Kills Mother: Effects On the Children
• Part III: Learning from experience
• Appendix 1: Interviewing the Traumatised Child
• Appendix 2: Principles and Practice In Child Law
• Appendix 3: The Classification of Posttraumatic Stress Disorder
• Appendix 4: Voluntary Help: Useful Addresses
• Appendix 5: Principles for Practice and Signposts for Future Work
• Glossary
• References