All the Love that Remains for a Child: Mourning Analysis in Coronavirus Time and General Trial to Face Up to Future Losses

The measures taken to limit social contacts in the period of the lockdown due to the Coronavirus-19 pandemic, led to a series of changes in the ways of social interaction which have determined (and will determine in the future), an emotional and psychological impact for everyone, in particular for children. They found themselves suddenly immersed in a reality outside normal frame of reference and routine, outside those “containers”, first of all the school, but also the group of friends, which guarantee certainty and predictability. In the most serious cases, the children also had to deal with the loss of a person with whom they had shared games and moments of life and who, perhaps, represented a figure reference, such as parents or grandparents.

The situation is made even more complicated by the fact that, at the moment of death, it was not possible to carry out all series of rites of passage, such as the funeral and the related traditions, which are important because they represent a sort of final greeting for the their culture.

The modality of expression chosen to face psychological trauma needs a specific language which fits for the child: for example Düss’s fables, the test of fairy tales, art therapy, dramatization and drawing. Whatever method is chosen, it must adapt to a series of new psychological problems that we, as professionals in the psychological and psychotherapeutic sector, are today having to deal with, as well as in the immediate future.

Analysis of a bereavement at the time of the coronavirus: through the eyes of a child

The emotional impact of the immediate cessation of traditional social interactions, the inability to say the final farewell to deceased loved ones, has been enormous for adults, and we can imagine the consequences more for the children. Even for children, in fact, the presence and participation in the mourning rituals is functional experience, because it allows them to feel an active part in giving farewell to the lost person. It would therefore be necessary, in all cases, but in particular when the capacity of the child transcend the possibility of facing traumatic events, going towards requesting for a specialistic help, whose success depends on a multiplicity of factors, such as the circumstances of death, the quality of the relationship that linked the child to the deceased person, the resources of those who remains close to the minor to cope with adverse events, the possibilities offered by the reference context, his personal resources, the presence of other bereavement, the quality of social relationships, the presence or absence of psychopathologies.

The importance of not underestimating the consequences of the situation of bereavement or loss resulting from Covid-19 is particularly relevant also in consideration of the fact that the onset of this disorder can also occur for some time after the emergency has ended. Psychological trauma derives from being exposed to an event that is perceived as potentially dangerous for one's life or that of others, or potentially capable of generating serious physical injury to oneself or to others. The limbic system intervenes in the processing of behaviors related to emotions such as fear or intense psychological pain and it is involved in the memorization processes. The amygdala plays a central role in this system related to the perception of fear and the processing of the resulting reactions. The amygdala is considered a sort of entrance door for the emotions that are registered here, triggering the adaptive physiological reactions. The consequences of the alterations of the cerebral circuits involved in the emotions connected to the mourning process have proved to be more serious, the earlier the age of the traumatized subject [1].

It is essential, with the help of a therapist, to implement some simple behaviors to accompany a child in his personal elaboration. From a practical point of view, it is important, in the days immediately following the bereavement, to find small rituals that can be performed at home, even better outdoors, with family members, perhaps repeated even for a few days, which can also allow the little ones to feel an active part of the farewell and to express pain and suffering for the loss suffered.

Elaboration of bereavement for a child: the importance of narration

As for the methods of elaboration through the narration, we can support the process by allowing the children to express on the delicate themes of grief and pain with their specific languages, which are different from those of adults, in order to validate their emotions. The important thing is that they express themselves in some way, not letting them face the suffering in silence, because this could lead to psychosomatic reactions, such as intestinal disorders, excessive agitation, insomnia or migraines, just to name a few [2,3].

Psychological investigation tools, such as the fables of Düss for example, where small fables or stories in which a protagonist finds himself in a specific situation that refers to one of the different stages of psychosexual development (oral, anal, oedipal, etc.). The method of the stories to be completed turns out to be a means of rapid investigation, replacing the child's direct psychoanalytic investigation. The tales conceived by Düss can be a means of quickly identifying any discomfort or suffering that overwhelms the child's ability to overcome them without therapeutic help, and their degree of severity which can serve as a starting point for psychotherapeutic intervention on the child. This useful tool is intended for children up to 11 years of age.

In the case of a therapeutic aid oriented to the elaboration of grief, one can choose from the ten stories. For example, the fourth is useful for investigating aggression, the desire for death, guilt, self-punishment. This fable could be used starting precisely on the difference between the period of the pandemic just experienced where the funeral did not take place and the theme of the story which is, in fact, 'the funeral'. The fifth is instead 'a story of fear', which provides valuable insights for investigating anguish and self-punishment; the ninth is 'the story of the news', useful for exploring the theme of the child's wishes or fears. Finally, the tenth, 'the bad dream' necessary for checking the previous fables [4].

Another test that optimizes the symbolic value of the stories is the fairy tale test (FTT - Fairy Tale Test) which uses as a stimulus a series of illustrated tables of the main characters of some widely known and widespread fairy tales, such as Snow White and the Seven Dwarfs, Little Red Riding Hood, Hansel and Gretel, Tom Thumb, Jack and the Beanstalk. Due to their symbolic content and structure, the tables are well suited to express central aspects of children's experience, fears, and anxieties [5].

The use of art therapy and dramatization is also particularly useful, also in consideration of the fact, which is already illustrated, the expression of emotions in children must take place using their personal way of expressing themselves and communicating [6]. This is a method of taking care of a person, especially a minor, with the expressive methods of artistic language, images or representations or stories. In the case of child drawing as a therapeutic means, a tool is available that can help to “read” behind the facade and then place oneself in the most suitable way to be a healthy overcoming of trauma and grief, and favor the consequent psychological development [7].

It is important to help children understand that they are not the only ones to have experienced the traumatic situation, as there are other children who, like them, may have lost a grandfather or another important person. This helps them feel less alone. It is also necessary to create situations where they can give vent to emotions through physical activity using outdoor spaces, to avoid the risks of a drop in their mood and sleeping disorders. It is also necessary to speak of death in a language accessible to them, as we have seen when talking about stories or fairy tales.

The advantages of being out in the open air and the benefits of contact with nature can be combined and optimized with those of intervention and therapeutic investigation. For example, a child can be asked to draw a tree; having this a psychological impact of different importance if the execution takes place in a room or in an open environment in the presence of trees. In the book by Bandinelli and Manes, "The drawing of the child in difficulty” [8], the “tree test”, the way in which the child draws the tree as a man, the crown, the stem, the branches, is an indicator of the difficulties that one experiences the moment of bereavement and loss, it is a useful tool for investigation and intervention through the free expression of one’s emotions and management in overcoming the trauma.

We are facing an important turning point both from a social and psychological point of view, because if on one hand it is true that the moment of the lockdown resulted in the necessity to suddenly face unexpected challenges for which we were not prepared, professionals in the sector must now offer specialized help to process the trauma suffered, on the other hand we are facing a “new normality”.

Everything has changed. The anxiety of the contagion has not ceased, it has been necessary to rewrite new ways of socializing, of learning, of working. And if these changes have had a huge impact on adults, we can only imagine what the consequences will be for children, who are in the existential stage in which the appropriate tools to cope with difficulties are developed. It is during the first years of life that children learn how to effectively deal with the first obstacles and problems, and at the same time they start to develop resilience, that is, the ability to react autonomously and effectively to trauma and difficulties. Resilience is therefore the ability to deal positively with traumatic events, to positively reorganize one's life in the face of difficulties, to rebuild oneself while remaining sensitive to the positive opportunities that life offers, without alienating one's identity [9]. This process of mobility and elasticity takes shape in the early stages of life and will be decisive and fundamental for the rest of an individual's existence, determining the personal way of dealing with difficulties and change throughout ones entire life [10,11].

If in the early stages of life, the trauma exceeds a child's ability to deal with it successfully, it will become a severe risk factor not only immediately, but also later. If the ability to self-repair lack, there is an important probability that the adolescent will tend to develop psychopathologies and maladaptive behaviors, first becoming a teenager at risk, then, as an adult, by manifesting psychopathological consequences such as conduct disorders, affective and deviant behaviors, due to the inability to adapt and successfully face life's challenges [3].

Now, therefore, the strength to successfully deal with trauma is sought by resorting to small everyday rituals, in family habits, which reconstruct lost certainties. This is because, a functional processing of the trauma must make use at this time tools capable of adapting to the 'new normality'. Whatever new normality emerges in the months and years to come, psychologists and psychotherapists of all stripes - school, community, research and more - should be part of the solution. The whole world is adapting right now, and professionals in the sector must know how to “take psychological science and apply it”, encouraging each other to step up and learn to improve our society.

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