Grief and Loss in Adolescence: Principles, responses and challenges

Topics: Grief, Grief counseling, Death Pages: 9 (2463 words) Published: December 22, 2013
Grief and Loss in Adolescence: Principles, responses and challenges

Introduction

Grief and loss are fundamental aspects of life; they are inevitabilities that stem from our mortality and our natural propensity to form deep emotional bonds with those closest to us—our family, friends and colleagues. Perhaps C. S. Lewis captured the sensation of grief best when he said:

“No one ever told me that grief felt so like fear. I am not afraid, but the sensation is like being afraid. The same fluttering in the stomach, the same restlessness, the yawning. I keep on swallowing. — C.S. Lewis, A Grief Observed

How one physically manifests grief may vary between age groups and cultures but it is a universal occurrence in humans who are of normal cognitive development.

In this paper, grief and loss will be reviewed in the context of Worden’s principles and theories; specifically, what these principles say about grief and loss, how they might apply to the adolescence demographic, what challenges the health care provider might expect to encounter when working with a grieving adolescent, and how a health care provider can best respond to a grieving teenager. A series of hypothetical acute care settings will be presented to illustrate how a nurse might best proceed in responding to a grieving adolescent.

Death during Adolescence

Adolescence is a transitionary stage of life that poses unique challenges for the individual. Change is the hallmark of this developmental period as teenagers struggle with hormonal changes, newfound desires for independence, confidence issues, and concerns about body image. Grief and loss during this stage of life, whether it be the loss of a parent, relative, or close friend, often greatly exacerbates the emotional state of a teen who is already experiencing the stresses associated with the transition from child to adult. According to Metzgar, typical grief responses of teenagers include anger, depression, withdrawal, frustration, confusion, acting out, and noncompliance (Metzgar, 2002).

Unlike young children, who often do not fully contemplate the finality of death, adolescents are usually aware that death is final (Freeman, 2005). According to Freeman, adolescents have the mature intellectual development necessary to understand the core concepts of death—universality, non-functionality, irreversibility, and causality—and can elucidate fully the details (Freeman, 2005). This greater understanding of death places adolescents closer to adults on the level of death awareness; however, teens may wonder if a dead person will return; this thinking may include supernatural elements as teens often associate an unexpected death or serious illness with a supernatural event or cause (Brewster, 1982).

An adolescents’ grief experience is highly personal in nature, and unlike adults, teens tend to grieve more intensely. Often their grief response is not expressed smoothly or continuously but takes the form of a series of punctuated outbursts; in some cases an adolescent may make a concerted effort to control his or her emotions (Worden, 1996). In attempting to control their emotions, a teen may retreat inwardly by immersing themselves in highly personal activities such as reading, writing, listening to music, or exercising; in other cases, a teen may want to release the anger and sadness associated with their grief; in this case, he or she may act out angry or antisocial behavior (Worden, 1996).

Of particular importance from a health care perspective is the recognition that teens often perceive death as something that happens to others even though they recognize that death is a phenomenon that can and will happen to everyone. When a teen is confronted with the death of a close friend or relative, their perception of death as being a phenomenon that is distant from them, is abruptly challenged. In the case of the death of a peer, death is often sudden—in an American study, the three leading...

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